Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists.
OBJECTIVE
To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.


METHODS
Surveys were mailed to all attending gastroenterologists (n = 53) and obstetricians (n = 99) at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician's prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.


RESULTS
With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda (20%) and tend to avoid the use of PEG solution (26%). With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most (51%), while magnesium citrate is used least often (38%).


CONCLUSIONS
It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physician's experiences and individual preferences.
Vinod
Jeevan
J
Department of Gastroenterology, Lenox Hill Hospital, and New York University School of Medicine, 100 East 77th Street, New York, NY 10021, 6 Black Hall, New York, USA.
Bonheur
Jennifer
J
Korelitz
Burton I
BI
Panagopoulos
Georgia
G
D002400:Cathartics / Q000009:adverse effects / Q000627:therapeutic use; D002755:Choice Behavior; D019343:Citric Acid / Q000009:adverse effects / Q000627:therapeutic use; D003113:Colonoscopy / Q000379:methods*; D003625:Data Collection; D005260:Female; D005762:Gastroenterology; D006801:Humans; D054368:Laxatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009774:Obstetrics; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use; D010710:Phosphates / Q000009:adverse effects / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D011247:Pregnancy
D002400:Cathartics; D054368:Laxatives; D009942:Organometallic Compounds; D010710:Phosphates; D019343:Citric Acid; D011092:Polyethylene Glycols; C110422:magnesium citrate; C018279:sodium phosphate