Abstract
Hypertensive disorders of pregnancy (HDP) increase postpartum morbidity and the need for effective pain management, particularly after cesarean delivery. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are effective analgesics but have historically been avoided in women with HDP due to potential blood pressure (BP) elevation. Current guidelines support postpartum NSAID use, but evidence remains limited. This systematic review and meta-analysis aim to evaluate the safety of ibuprofen compared with acetaminophen for postpartum BP control in women with HDP. Following PRISMA guidelines, PubMed, Ovid Medline, and the Cochrane Library were searched for randomized controlled trials (RCTs). Risk of bias was evaluated using the Cochrane RoB2 tool, and meta-analyses were performed using RevMan software. Six RCTs including 535 patients were included. Of these, 269 (50.3%) were assigned to the ibuprofen group, with a mean age of 30.20 ± 6.07 years; and 266 (49.7%) were assigned to the acetaminophen group, with a mean age of 29.14 ± 6.42 years. Pooled analyses showed no significant differences between ibuprofen and acetaminophen in severe postpartum hypertension (OR 1.15, 95% CI 0.75–1.75), systolic BP (MD 1.31 mmHg, 95% CI −1.60 to 4.22), diastolic BP (MD 1.81 mmHg, 95% CI −0.26 to 3.88), mean arterial pressure (MD 0.03 mmHg, 95% CI −1.82 to 1.88), or antihypertensive use (OR 1.00, 95% CI 0.61–1.63). Secondary outcomes, including time to BP control, hospital stay, opioid use, diuresis, and readmission, were also comparable between groups. These findings suggest that short-term postpartum ibuprofen does not increase blood pressure compared with acetaminophen in women with HDP.
Data availability
Data will be available from the correspondence author upon a reasonable request.
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Acknowledgments
The researchers would like to thank the Deanship of Graduate Studies and Scientific Research at Qassim University for financial support (QU-APC-2026).
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Conceptualization, Zainah Abdulbari Alhebshi and Sahar Mohammad Altaweel and Nadiah AlHabardi; Formal analysis, Zainah Abdulbari Alhebshi and Sahar Mohammad Altaweel and Talal Mohammed Zagzoog; Supervision, Zainah Abdulbari Alhebshi and Nadiah AlHabardi; Writing - original draft, Zainah Abdulbari Alhebshi and Sahar Mohammad Altaweel and Talal Mohammed Zagzoog and Raya Tariq Albenayan and Marwah Nasir Ahmad; Writing – review and editing, Zainah Abdulbari Alhebshi and Manar Ali Alzaher and Khaled Waleed Al Assiri and Joudy Anas Moallem and Sarah Fuad Qaid; Data curation, Raya Tariq Albenayan and Marwah Nasir Ahmad and Manar Ali Alzaher and Khaled Waleed Al Assiri; Methodology, Joudy Anas Moallem and Sarah Fuad Qaid. All authors have read and agreed to the published version of the manuscript. Zainah Abdulbari Alhebshi: Conceptualization, Formal analysis, Supervision, Writing - original draft, Writing – review and editing. Sahar Mohammad Altaweel: Conceptualization, Formal analysis, Writing - original draft. Talal Mohammed Zagzoog: Formal analysis, Writing - original draft. Raya Tariq Albenayan: Writing - original draft, Data curation. Marwah Nasir Ahmad : Writing - original draft, Data curation. Manar Ali Alzaher: Writing – review and editing, Data curation. Khaled Waleed Al Assiri: Writing – review and editing, Data curation. Joudy Anas Moallem: Writing – review and editing, Methodology. Sarah Fuad Qaid: Writing – review and editing, Methodology. Nadiah AlHabardi: Conceptualization, Supervision, Writing - review and editing.
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Alhebshi, Z.A., Altaweel, S.M., Zagzoog, T.M. et al. Effect of ibuprofen versus acetaminophen on postpartum hypertension: a systematic review and meta-analysis of randomized controlled trials. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44647-6
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DOI: https://doi.org/10.1038/s41598-026-44647-6
