Ibuprofen vs. Acetaminophen After Delivery in Women with Hypertensive Disorders of Pregnancy: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background/Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for postpartum pain management. However, previous studies have indicated that NSAIDs may increase systolic blood pressure, particularly in patients receiving antihypertensive therapy. The aim of the present study was to assess whether postpartum ibuprofen administration is associated with a higher risk of severe postpartum hypertension and increased mean arterial pressure (MAP) compared with acetaminophen. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science to identify relevant studies. Only randomized controlled trials were considered eligible for inclusion. For dichotomous outcomes, effect sizes were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CIs). For continuous outcomes, mean differences (MDs) with 95% CIs were calculated. Statistical heterogeneity among studies was assessed using the I2 statistic. A fixed-effects model was applied in cases of low heterogeneity (I2 < 20%). Results: No significant difference was observed in the prevalence of severe postpartum hypertension between the ibuprofen and acetaminophen groups (RR 1.07, 95% CI 0.84 to 1.35; p = 0.59; I2 = 0%). Similarly, MAP did not differ significantly between groups (MD −0.05 mmHg, 95% CI −1.53 to 1.42; p = 0.94; I2 = 0%). Conclusions: No increased risk of postpartum hypertension or difference in mean arterial pressure was observed between the ibuprofen and acetaminophen groups, supporting the safety of ibuprofen for postpartum analgesia in women with hypertensive disorders of pregnancy.