Postpartum nonsteroidal anti-inflammatory drug exposure does not increase risk for flare in patients with inflammatory bowel disease

Loren G. Rabinowitz; Tina Deyhim; Joyce Lee; Jessica D. Lee; Amelia Hern; Nicole Lue; Grace Geeganage; Alessandra Saraga; Ajay Gade; Jacqueline Shen; Sarah Ballou; Lauren K. Burdine; Benjamin Mecsas-Faxon; Laurie Grossberg; Samantha Zullow; Sarah Flier; Scott A. Shainker; Konstantinos Papamichael; Joseph D. Feuerstein; Adam Cheifetz

Authors Loren G. Rabinowitz, Tina Deyhim, Joyce Lee, Jessica D. Lee, Amelia Hern, Nicole Lue, Grace Geeganage, Alessandra Saraga, Ajay Gade, Jacqueline Shen, Sarah Ballou, Lauren K. Burdine, Benjamin Mecsas-Faxon, Laurie Grossberg, Samantha Zullow, Sarah Flier, Scott A. Shainker, Konstantinos Papamichael, Joseph D. Feuerstein, Adam Cheifetz.

Abstract

Background Postpartum pain management is an important part of maternal healthcare. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are typically offered as firstline pharmacologic therapies for postpartum pain. There is a belief that NSAIDs may play a role in exacerbating inflammatory bowel disease (IBD); as a result, some obstetricians avoid NSAIDs for postpartum pain management in patients with IBD. However, data concerning the relationship between short-term NSAID use and IBD flares are inconsistent. The aim of this study was to assess whether hospital postpartum NSAID use is associated with postpartum IBD flare within 9 months from delivery.

Methods This single-center retrospective cohort study included patients with IBD, aged 18 years or older, who had singleton live births between January 1, 2016, and November 30, 2023. Chart review data for each eligible patient were collected for a 9-month postpartum period.

Results Among the 187 patients included in the study, there was no difference between NSAID-exposed and non-exposed patients in postpartum IBD flare: 10/114 (9%) vs. 10/73 (14%), respectively, P=0.335. Based on multivariate regression analysis, NSAID exposure was not associated with postpartum IBD flare, adjusted for active disease at conception and IBD flare during pregnancy: adjusted odds ratio (aOR) 0.6, 95% confidence interval (CI) 0.2-1.7; P=0.327. The same was true for mode of delivery and inpatient opioid exposure: aOR 0.6, 95%CI 0.1-1.5; P=0.291.

Conclusions Postpartum NSAID use for pain control is not associated with IBD flare 9 months after delivery. Large prospective studies are needed to confirm this finding.

Keywords Nonsteroidal anti-inflammatory drugs, pregnancy, inflammatory bowel disease, flare

Ann Gastroenterol 2026; 39 (3): 372-377