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Chenxing W, Jie S, Yajuan T, Ting L, Yuying Z, Suhong C, Guiyuan L. The rhizomes of Atractylodes macrocephala Koidz improve gastrointestinal health and pregnancy outcomes in pregnant mice via modulating intestinal barrier and water-fluid metabolism. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117971. [PMID: 38403003 DOI: 10.1016/j.jep.2024.117971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Baizhu (BZ) is the dried rhizome of Atractylodes macrocephala Koidz (Compositae), which invigorates the spleen, improves vital energy, stabilizes the fetus, and is widely used for treating spleen deficiency syndrome. However, the impact of BZ on gastrointestinal function during pregnancy remains unexplored. AIM OF THE STUDY This study elucidated the ameliorative effects of BZ on gastrointestinal health and pregnancy outcomes in pregnant mice with spleen deficiency diarrhea (SDD). METHODS To simulate an irregular human diet and overconsumption of cold and bitter foods leading to SDD, a model of pregnant mice with SDD was established using an alternate-day fasting and high-fat diet combined with oral administration of Sennae Folium. During the experiment, general indicators and diarrhea-related parameters were measured. Gastric and intestinal motility (small intestinal propulsion and gastric emptying rates) were evaluated. Serum motilin (MTL), ghrelin, growth hormone (GH), gastrin (Gas), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), chorionic gonadotropin β (β-CG), progesterone (P), and estradiol (E2) were quantified using an enzyme-linked immunosorbent assay. Pathological changes were examined by hematoxylin and eosin staining (H&E) and alcian blue periodic acid Schiff staining (AB-PAS). Immunohistochemistry and immunofluorescence were used to measure the expression levels of the intestinal barrier and water metabolism-related proteins in colonic tissues. The pregnancy rate, ovarian organ coefficient, uterus with fetus organ coefficient, small size, average fetal weight, and body length of fetal mice were calculated. RESULTS The results showed that BZ significantly improved general indicators and diarrhea in pregnant mice with SDD, increased gastric emptying rate and small intestinal propulsion rate, elevated the levels of gastrointestinal hormones (AMS, ghrelin, GH, and Gas) in the serum, and reduced lipid levels (TC and LDL-c). It also improved colonic tissue morphology, increased the number of goblet cells, and promoted the mRNA and protein expression of occludin, claudin-1, ZO-1, AQP3, AQP4, and AQP8 in colonic tissues, downregulating the mRNA and protein expression levels of claudin-2, thereby alleviating intestinal barrier damage and regulating the balance of water and fluid metabolism. BZ also held the levels of pregnancy hormones (β-CG, P, and E2) in the serum of pregnant mice with SDD. Moreover, it increased the pregnancy rate, ovarian organ coefficient, uterus with fetus organ coefficient, litter size, average fetal weight, and body length of fetal mice. These findings indicate that BZ can improve spleen deficiency-related symptoms in pregnant mice before and during pregnancy, regulate pregnancy-related hormones, and improve pregnancy outcomes.
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Affiliation(s)
- Wang Chenxing
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China
| | - Su Jie
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China
| | - Tian Yajuan
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China
| | - Li Ting
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China
| | - Zhong Yuying
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China
| | - Chen Suhong
- Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, Hangzhou, China.
| | - Lv Guiyuan
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, 310053, China.
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Harada M, Tsuboyama-Kasaoka N, Yonekura Y, Shimoda H, Ogawa A, Kobayashi S, Sakata K, Nishi N. Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study. J Epidemiol 2024; 34:164-169. [PMID: 37635084 PMCID: PMC10918335 DOI: 10.2188/jea.je20220284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/03/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown. METHODS Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model. RESULTS In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation. CONCLUSION The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.
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Affiliation(s)
- Moeka Harada
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | | | | | | | | | | | | | - Nobuo Nishi
- National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- St. Luke’s International University, Tokyo, Japan
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Lu C, Luo H, Wang Y, Jing S, Zhao J, Zou K, Wu F, Ying H. Regulation of PDGFRα + cells and ICC in progesterone-mediated slow colon transit in pregnant mice. Heliyon 2024; 10:e25227. [PMID: 38333873 PMCID: PMC10850515 DOI: 10.1016/j.heliyon.2024.e25227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
Background Progesterone can inhibit intestinal smooth muscle contraction; however, the specific mechanism remains unclear. Besides smooth muscle cells, smooth muscle has two important mesenchymal cells, namely interstitial cells of Cajal (ICC) and PDGFRα+ cells, which induce the contraction and relaxation of smooth muscles. We aimed to explore the regulation of PDGFRα+ cells and ICC in progesterone-mediated colon slow transit in pregnant mice. Methods Colon transit experiments were performed in vivo and in vitro to observe slow colon transit. The expression of PDGFRα and c-KIT was detected by Western blot, RT-PCR, and immunofluorescence. An isometric tension experiment was performed to investigate smooth muscle contractions. Results The colon transit time in pregnant mice was longer than that in non-pregnant mice. Progesterone significantly blocks colonic smooth muscle contractions. However, when the relaxation and contraction of PDGFRα+ cells and ICC are blocked, progesterone cannot inhibit smooth muscle contraction. When the function of only PDGFRα+ cells are blocked, progesterone has a more obvious inhibitory effect on smooth muscle in the non-pregnant group than that in the pregnant group. However, when ICC alone was blocked, progesterone inhibited smooth muscle contractions more clearly in pregnant mice. The protein and mRNA expression of PDGFRα was higher and c-KIT was lower in pregnant mice. PDGFRα+ cells and ICC from smooth muscle all co-localize progesterone receptors. Conclusions Under the regulation of progesterone, the relaxation function of PDGFRα+ cells is enhanced and the contraction function of ICC is weakened, leading to the slow colon transit of pregnant mice.
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Affiliation(s)
- Chen Lu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
- Hospital and Institute of Obstetrics and Gynecology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hui Luo
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
| | - Ye Wang
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Shuang Jing
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jun Zhao
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Kexin Zou
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Fan Wu
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hao Ying
- Department of Obstetrics and Gynecology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
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De Guadalupe Quintana-Coronado M, Bravo C, Álvarez-Mon M, Ortega MA, De León-Luis JA. News in pharmacology for the main medical pathologies of gestation. Front Pharmacol 2024; 14:1240032. [PMID: 38239189 PMCID: PMC10794658 DOI: 10.3389/fphar.2023.1240032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
Obstetric diseases represent a highly complex medical challenge, especially regarding its clinical approach. The use of pharmacological agents during pregnancy is one of the main therapeutic alternatives in this group of patients; however, there is a general lack of knowledge about its use, efficacy, and possible adverse effects that may occur in routine clinical practice, even among medical professionals themselves. The high percentage of pregnant women who undergo drugs at some point during pregnancy, together with the developments that have occurred in recent years in the field of pharmacology, show the need for a detailed analysis that shows the existing current knowledge and helps in the clinical decision making. In this sense, the aim of this work is to conduct a review of the available scientific literature on the novelties in pharmacology for the main medical pathologies of pregnancy. Thus, the role of this field in analgesia, antibiotic therapy, digestive, respiratory, urological, psychiatric and neurological pathologies will be detailed, evaluating the indications, precautions and considerations that must be taken into account for its use.
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Affiliation(s)
- María De Guadalupe Quintana-Coronado
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Coral Bravo
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Alcalá de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Juan A. De León-Luis
- Department of Public and Maternal and Child Health, School of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Obstetrics and Gynecology, University Hospital Gregorio Marañón, Madrid, Spain
- Health Research Institute Gregorio Marañón, Madrid, Spain
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5
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Long ES, Penalver Bernabe B, Xia K, Azcarate-Peril MA, Carroll IM, Rackers HS, Grewen KM, Meltzer-Brody S, Kimmel MC. The microbiota-gut-brain axis and perceived stress in the perinatal period. Arch Womens Ment Health 2023; 26:227-234. [PMID: 36897389 PMCID: PMC10063483 DOI: 10.1007/s00737-023-01300-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/11/2023]
Abstract
Perinatal perceived stress can contribute to worse health outcomes for the parent-child dyad. Given the emerging relationship between the microbiota-gut-brain axis and stress, this study sought to elucidate connections between bowel symptoms and the gut microbiome in relation to perceived stress at three time points in the perinatal period: two during pregnancy and one postpartum. Ninety-five pregnant individuals participated in a prospective cohort study from April 2017 to November 2019. Researchers assessed Perceived Stress Scale-10 (PSS); bowel symptoms (according to the IBS Questionnaire); psychiatrist assessment of new onset or exacerbated depression and anxiety; and fecal samples analyzed for alpha diversity (measures of gut microbiome diversity utilizing Shannon, Observed OTUs, and Faith's PD) at each timepoint. Covariates included weeks of gestation and weeks postpartum. PSS scores were divided into "Perceived Self-Efficacy" and "Perceived Helplessness." Increased gut microbial diversity was associated with decreased bowel symptoms, decreased overall perceived stress, increased ability to cope with adversity, and decreased distress in the postpartum period. This study found a significant association between a less diverse microbial community, lower self-efficacy early in pregnancy, and greater bowel symptoms and perceived helplessness later in the perinatal period, relationships that may ultimately point to novel diagnostic methods and interventions for perceived stress based on the microbiota-gut-brain axis.
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Affiliation(s)
- Emily S Long
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Beatriz Penalver Bernabe
- Department of Biomedical Engineering, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Kai Xia
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - M Andrea Azcarate-Peril
- Departments of Medicine and Nutrition, Microbiome Core, University of North Carolina, Chapel Hill, NC, USA
| | - Ian M Carroll
- Department of Nutrition, University of North Carolina Gillings School of Public Health, Chapel Hill, NC, USA
| | - Hannah S Rackers
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Karen M Grewen
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - Mary C Kimmel
- Department of Psychiatry, University of North Carolina School of Medicine, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
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Brigstocke S, Yu V, Nee J. Review of the Safety Profiles of Laxatives in Pregnant Women. J Clin Gastroenterol 2022; 56:197-203. [PMID: 35050942 DOI: 10.1097/mcg.0000000000001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Chronic constipation is one of the most common complaints seen in the gastroenterology clinic and is particularly prevalent in women. Women who become pregnant may suffer from existing constipation or develop constipation de novo. A thorough understanding of the safety of laxative therapies during pregnancy and the postpartum period is essential to successfully treating these women. Current understanding of the safety of both over the counter and prescription laxatives has not been adequately evaluated. In this article we provide an updated and comprehensive review of the safety profiles of laxatives that are currently used for the treatment of chronic constipation to aid the clinician in risk-benefit discussions with women who are currently or planning to become pregnant.
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Affiliation(s)
- Sophie Brigstocke
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Corsetti M, Landes S, Lange R. Bisacodyl: A review of pharmacology and clinical evidence to guide use in clinical practice in patients with constipation. Neurogastroenterol Motil 2021; 33:e14123. [PMID: 33751780 PMCID: PMC8596401 DOI: 10.1111/nmo.14123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bisacodyl is a member of the diphenylmethane family and is considered to be a stimulant laxative. It has a dual prokinetic and secretory action and needs to be converted into the active metabolite bis-(p-hydroxyphenyl)-pyridyl-2-methane (BHPM) in the gut to achieve the desired laxative effect. Bisacodyl acts locally in the large bowel by directly enhancing the motility, reducing transit time, and increasing the water content of the stool. A recent network meta-analysis concluded that bisacodyl showed similar efficacy to prucalopride, lubiprostone, linaclotide, tegaserod, velusetrag, elobixibat, and sodium picosulfate for the primary endpoint of ≥3 complete spontaneous bowel movements (CSBM)/week and an increase of ≥1 CSBM/week over baseline. The meta-analysis also found that bisacodyl may be superior to the other laxatives for the secondary endpoint of change from baseline in the number of spontaneous bowel movements per week in patients with chronic constipation. This observation stimulated the authors to review the available literature on bisacodyl, which has been available on the market since the 1950 s. PURPOSE The aim of the current review was to provide an overview of the historic background, structure, function, and mechanism of action of bisacodyl. Additionally, we discuss the important features and studies for bisacodyl to understand its peculiar characteristics and guide its use in clinical practice, but also stimulate research on open questions.
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Affiliation(s)
- Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC),Nottingham University Hospitals NHS TrustUniversity of NottinghamNottinghamUK
- Nottingham Digestive Diseases CentreSchool of MedicineUniversity of NottinghamNottinghamUK
| | - Sabine Landes
- Consumer Health CareMedical Affairs ‐ Digestive HealthSanofi‐Aventis Deutschland GmbHFrankfurt am MainGermany
| | - Robert Lange
- Consumer Health CareGlobal Medical AffairsSanofi‐Aventis Deutschland GmbHFrankfurt am MainGermany
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Abbasalizadeh S, Ebrahimi B, Azizi A, Dargahi R, Tayebali M, Ghadim ST, Foroumandi E, Aliasghari F, Javadi M, Izadi A, Banifatemeh L, Pourjafar H, Khalili L, Ghalichi F, Houshmandi S, Rad AH. Review of Constipation Treatment Methods with Emphasis on Laxative Foods. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401315666191002164336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Constipation is a common public health concern experienced by all individuals during
their life affecting the quality of life. In this paper, we aimed to provide an overview of the existing
evidence regarding the role of food ingredients, including bran, prune, fig, kiwifruit, and flax-seed in
constipation treatment. We searched Scopus, Pub Med, and Science Direct by using the keywords,
“laxative foods” and “constipation”, for searching studies assessing laxative food ingredients and
their beneficial effects on constipation treatment and/or control. Lifestyle modifications such as increasing
dietary fiber and fluid intake and daily exercise are the proposed first line treatments for
constipation. Optimizing ‘diet’ as an efficient lifestyle factor may contribute to the well-being of patients.
The use of laxative food ingredients including bran, prune, fig, kiwifruit, flax-seed, probiotics,
and prebiotics is a convenient alternative to cope with constipation. According to previous findings,
laxative food ingredients could be considered as effective treatments for subjects suffering from constipation.
Many studies have assessed the pharmacological and non-pharmacological roles of these
ingredients in treating constipation, however, their importance has not been thoroughly investigated.
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Affiliation(s)
- Shamsi Abbasalizadeh
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Ebrahimi
- Department of Food Science and Technology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Aslan Azizi
- Agricultural Engineering Research Institute, Ministry of Jihad Agriculture, Karaj, Iran
| | - Rogaye Dargahi
- Obstetrics and Gynecology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Maryam Tayebali
- Department of Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Sepideh T. Ghadim
- Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elaheh Foroumandi
- Nutrition Research Center, School of Nutrition, Tabriz University of Medical Science, Tabriz, Iran
| | - Fereshteh Aliasghari
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Javadi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azimeh Izadi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Banifatemeh
- Department of Food Science & Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Pourjafar
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Leila Khalili
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Ghalichi
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sousan Houshmandi
- Faculty of Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aziz H. Rad
- Department of Food Science & Technology, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Matos JF, Americo MF, Sinzato YK, Volpato GT, Corá LA, Calabresi MFF, Oliveira RB, Damasceno DC, Miranda JRA. Role of sex hormones in gastrointestinal motility in pregnant and non-pregnant rats. World J Gastroenterol 2016; 22:5761-5768. [PMID: 27433089 PMCID: PMC4932211 DOI: 10.3748/wjg.v22.i25.5761] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/07/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant (estrous cycle) and pregnant rats using noninvasive techniques.
METHODS: Female rats (n = 23) were randomly divided into (1) non-pregnant, (contractility, n = 6; transit, n = 6); and (2) pregnant (contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry (ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination.
RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions (3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying (168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control (54.23 ± 15.14 ng/mL and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0 (44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL).
CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.
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Body C, Christie JA. Gastrointestinal Diseases in Pregnancy: Nausea, Vomiting, Hyperemesis Gravidarum, Gastroesophageal Reflux Disease, Constipation, and Diarrhea. Gastroenterol Clin North Am 2016; 45:267-83. [PMID: 27261898 DOI: 10.1016/j.gtc.2016.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many disorders of the gastrointestinal tract are common in pregnancy. Elevated levels of progesterone may lead to alterations in gastrointestinal motility which could contribute to nausea, vomiting, and/or GERD. Pregnancy-induced diarrhea may be due to elevated levels prostaglandins. This article reviews the normal physiologic and structural changes associated with pregnancy that could contribute to many of the common gastrointestinal complaints in pregnant patients. Additionally, the appropriate clinical and laboratory evaluations, other pathologic conditions that should be included in the differential, as well as the nonpharmacologic and pharmacologic therapies for each of these conditions is discussed.
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Affiliation(s)
- Cameron Body
- Department of Internal Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Suite 1264, Atlanta, GA 30322, USA
| | - Jennifer A Christie
- Department of Internal Medicine, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Suite 1264, Atlanta, GA 30322, USA.
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Li Z, Pergolizzi JV, Huttner RP, Zampogna G, Breve F, Raffa RB. Management of opioid-induced constipation in pregnancy: a concise review with emphasis on the PAMORAs. J Clin Pharm Ther 2015; 40:615-9. [DOI: 10.1111/jcpt.12331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Z. Li
- Temple University School of Pharmacy; Philadelphia PA USA
| | - J. V. Pergolizzi
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Pharmacology; Temple University School of Medicine; Philadelphia PA USA
- Association of Chronic Pain Patients; Houston TX USA
| | - R. P. Huttner
- Women's Health Center of Hunterdon County; Flemington NJ USA
| | | | - F. Breve
- Temple University School of Pharmacy; Philadelphia PA USA
| | - R. B. Raffa
- Temple University School of Pharmacy; Philadelphia PA USA
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Abstract
BACKGROUND Although some studies have analyzed the prevalence of urinary incontinence during pregnancy, there are scarce data on the frequency and characteristics of fecal incontinence during this period. OBJECTIVE The aim of this study was to determine the incidence and characteristics of women with fecal incontinence symptoms during early and late pregnancy, to evaluate its impact on quality of life, and to identify whether there is a specific clinical pattern that could identify patients at risk. DESIGN This was a cross-sectional observational study. SETTINGS The study was conducted at the maternity unit of a university tertiary care center. PATIENTS Pregnant women undergoing obstetric follow-up were included in the study. MAIN OUTCOME MEASURES A prospective study was conducted. All of the patients attending our maternity unit for obstetric ultrasound examination during the first and third trimesters were eligible for inclusion. Selected patients completed a self-reported questionnaire that included items on fecal incontinence, Wexner score, and stool consistency. Quality of life was assessed using the Medical Outcomes Study Short Form 36. RESULTS The study included 228 consecutive pregnant women. Ninety-three patients (40.8%) had some episode of fecal incontinence in the 4 weeks before the survey, 15 patients with solid stool, 6 patients with liquid stools, and 72 with flatus. In these patients, the mean Wexner score was 3.82 (range, 2.0-13.0). In patients with incontinence, quality of life was significantly affected in most subscales of Medical Outcomes Study Short Form 36. There were no significant differences in the following variables between patients with and without symptoms of fecal incontinence, including age (p = 0.090), BMI (p = 0.094), history of previous deliveries (p = 0.492), trimester of pregnancy (p = 0.361), and Bristol Stool Form Scale (p = 0.388). LIMITATIONS The cross-sectional design hampered identification of specific time at which the impact of pregnancy occurred. CONCLUSIONS The prevalence of fecal incontinence is high during pregnancy with a notable impact on quality of life. There was no specific clinical pattern during pregnancy that could define patients at risk for fecal incontinence during this period of life.
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13
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Iron bioavailability from commercially available iron supplements. Eur J Nutr 2014; 54:1345-52. [DOI: 10.1007/s00394-014-0815-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/05/2014] [Indexed: 12/15/2022]
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14
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Risk factors for the development of stress urinary incontinence during pregnancy in primigravidae: a review of the literature. Eur J Obstet Gynecol Reprod Biol 2014; 178:27-34. [DOI: 10.1016/j.ejogrb.2014.04.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 02/10/2014] [Accepted: 04/08/2014] [Indexed: 12/30/2022]
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15
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de Milliano I, Tabbers MM, van der Post JA, Benninga MA. Is a multispecies probiotic mixture effective in constipation during pregnancy? 'A pilot study'. Nutr J 2012; 11:80. [PMID: 23035837 PMCID: PMC3502183 DOI: 10.1186/1475-2891-11-80] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/21/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Constipation during pregnancy is a common problem. Nowadays only few effective interventions are published preventing or treating constipation during pregnancy. However, their use is limited due to side-effects. This uncontrolled intervention study was performed to determine if a mixture of probiotics in the treatment of constipation during pregnancy is effective. METHODS Women aged ≥ 18 years with functional constipation were included at the Obstetrical outpatient clinic and midwife practices. Patients received during four weeks a daily dose of Ecologic®Relief (Bifidobacterium bifidum W23, Bifidobacterium lactis W52, Bifidobacterium longum W108, Lactobacillus casei W79, Lactobacillus plantarum W62 and Lactobacillus rhamnosus W71 (total 4*10⁹ CFU)). For all analyses, the non-parametric paired Wilcoxon test was used. Primary outcome measure was change in defecation frequency. Secondary outcome measures were stool consistency, sensation of incomplete evacuation, sensation of anorectal obstruction, manual manoeuvres to facilitate defecation, abdominal pain, adverse effects, presence of reflux episodes and intake of Bisacodyl. RESULTS 20 women were included. Defecation frequency significantly increased from 3.1 at baseline to 6.7 in week four (p < 0.01). Compared to baseline, a significant decrease in 1) sensation of anorectal obstruction from 90.0% to 45.0% (p < 0.01), 2) sensation of incomplete evacuation from 90.0% to 40.0% (p < 0.01), 3) straining during defecation from 100% to 65% (p = 0.01), 4) episodes of abdominal pain from 60% to 20% (p = 0.01) and 5) the presence of reflux episodes from 60% to 20% in week four (p = 0.01) was found. Other secondary outcomes did not decrease significantly. No side effects were reported. CONCLUSIONS Ecologic®Relief is effective in the treatment of constipation during pregnancy. A randomised placebo controlled trial is required to confirm these data.
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Affiliation(s)
- Inge de Milliano
- Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital/ Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Merit M Tabbers
- Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital/ Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris A van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children’s Hospital/ Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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16
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Longo SA, Moore RC, Canzoneri BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg 2011; 23:80-9. [PMID: 21629625 DOI: 10.1055/s-0030-1254294] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pregnancy causes anatomic and physiologic changes in the gastrointestinal tract. Pregnant women with intestinal disease such as Crohn disease or ulcerative colitis pose a management challenge in clinical diagnosis, radiologic evaluation, and treatment secondary to potential risk to the fetus. Heightened physician awareness on possible etiologies such as appendicitis, diverticulitis, and rarely colorectal cancer is required for rapid diagnosis and treatment to improve maternal/fetal outcome. A multidisciplinary approach to evaluation is a necessity because radiologic procedures and treatment medications commonly used in nonpregnant patients may have a potential harmful effect on the fetus. The authors review several gastrointestinal conditions encountered during pregnancy and address presentation, diagnosis, and treatment of each condition.
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Affiliation(s)
- Sherri A Longo
- Department of Obstetrics and Gynecology, Section of Maternal-Fetal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana
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18
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Abstract
Pregnancy, whether normal or complicated, induces change in nearly every system of the body. Because most rheumatologic disorders are multisystemic and often affect young women, it may be difficult to differentiate pregnancy-related change from new onset or exacerbation of rheumatic disease. Familiarity with common manifestations of pregnancy is important in evaluating young women of childbearing age,whether or not they have known rheumatologic disease. Presentation of new connective tissue disease during pregnancy is often associated with poorer prognosis, so it is especially important to distinguish between pregnancy-induced change and true autoimmune inflammation requiring prompt and aggressive therapy.
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Affiliation(s)
- Lisa R Sammaritano
- Rheumatology Division, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.
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19
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Khatun M, Clavarino AM, Callaway L, Alati R, Najman JM, Williams G, Al Mamun A. Common symptoms during pregnancy to predict depression and health status 14 years post partum. Int J Gynaecol Obstet 2008; 104:214-7. [PMID: 19036371 DOI: 10.1016/j.ijgo.2008.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/13/2008] [Accepted: 10/20/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the prospective association between symptoms commonly experienced during pregnancy and the mental and general health status of women 14 years post partum. METHODS Data used were from the Mater-University of Queensland Study of Pregnancy, a community-based prospective birth cohort study begun in Brisbane, Australia, in 1981. Logistic regression analyses were conducted. RESULTS Data were available for 5118 women. Women who experienced a higher burden of symptoms during pregnancy were at greater risk of becoming depressed and reporting poorer health status 14 years post partum. Women who experienced major problems during pregnancy were 4 times more likely to be depressed and nearly 8 times more likely to report poorer health status 14 years after the index pregnancy compared with women who experienced few problems. CONCLUSIONS Findings suggest that pregnant women who experience common symptoms during pregnancy are likely to experience poorer mental and self-reported general health 14 years after the pregnancy.
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20
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Cheng L, Pricolo V, Biancani P, Behar J. Overexpression of progesterone receptor B increases sensitivity of human colon muscle cells to progesterone. Am J Physiol Gastrointest Liver Physiol 2008; 295:G493-502. [PMID: 18776045 PMCID: PMC2536785 DOI: 10.1152/ajpgi.90214.2008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Colon muscle strips and cells from female patients with slow-transit constipation (STC) exhibit impaired motility, signal transduction abnormalities characterized by downregulation of Gq/11 and upregulation of Gs proteins, decreased cyclooxygenase (COX)-1 and thromboxane (Tx)B2 levels, increased COX-2 and PGE2 levels, and overexpression of progesterone receptors (PGR). Progesterone (P4) treatment of normal cells reproduced these motility and signal transduction abnormalities. The purpose of the study was to examine whether overexpression of PGR-B reproduces these abnormalities by rendering the cells more sensitive to physiological concentrations of P4. Cultured human colon muscle was transfected with a plasmid DNA expressing PGR-B. The mRNAs of PGR, COX-1, COX-2, and Gq/11 were determined by quantitative real-time PCR. Their protein expression was determined by Western blot, and prostaglandins were measured by radioimmunoassay. Cultured muscle cells maintained their phenotypic features determined with myosin light chain (MLC) and h-caldesmon antibodies. Control and transfected muscle cells responded to 10(-6) M P4. In contrast, muscle cells transfected with PGR-B responded to lower P4 concentration (10(-7) M). This P4 concentration reduced MLC phosphorylation induced by CCK-8 (10(-8) M), downregulated Gq/11, and decreased COX-1 and TxB2 levels. It upregulated Gs proteins. It also increased COX-2 and PGE2 levels. We conclude that overexpression of PGR-B renders the cells more sensitive to physiological concentrations of P4. These results are consistent with the hypothesis that overexpression of PGR-B contributes to the motility and signal transduction abnormalities observed in female patients with STC and normal serum levels of P4.
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Affiliation(s)
- Ling Cheng
- Departments of Medicine and Surgery, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Victor Pricolo
- Departments of Medicine and Surgery, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Piero Biancani
- Departments of Medicine and Surgery, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jose Behar
- Departments of Medicine and Surgery, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
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21
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Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria. Eur J Gastroenterol Hepatol 2008; 20:56-61. [PMID: 18090992 DOI: 10.1097/meg.0b013e3281108058] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
An increase in the prevalence of constipation during pregnancy has been suggested to occur. We designed a prospective study to evaluate the prevalence of constipation during pregnancy and puerperium, to investigate possible associations with eating habits and lifestyle, and to evaluate the frequency of laxative use. A structured questionnaire was developed addressing demographics, obstetric characteristics, lifestyle, eating habits, variables required for the diagnosis of constipation, and laxative use to evaluate the prevalence of constipation during pregnancy and puerperium. The questionnaire was administered in the obstetric clinic in the first trimester of pregnancy, and by telephone in the second and third trimesters, and in the puerperal period. The prevalence of self-reported constipation in these time periods was 45.4, 37.1, 39.4, and 41.8%, respectively. Prevalence defined by the Rome II criteria for the same time periods was 29.6, 19, 21.8, and 24.7%. These values were similar to the data previously reported for the female population. Agreement between the self-reported and Rome II results was moderate. The self-reported criterion showed high sensitivity in all time periods, using the Rome II criterion as gold-standard. No factor was associated with variations in the prevalence of constipation during pregnancy, though an increase was recorded in the consumption of fruit, vegetables, fiber, and water. The prevalence of constipation during pregnancy and puerperium is similar to that recorded among the female population from the same geographic area.
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22
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Vinod J, Bonheur J, Korelitz BI, Panagopoulos G. Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists. World J Gastroenterol 2007; 13:6549-52. [PMID: 18161925 PMCID: PMC4611294 DOI: 10.3748/wjg.v13.i48.6549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: 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%).
CONCLUSION: 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 physicians’ experiences and individual preferences.
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23
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Moffatt DC, Bernstein CN. Drug therapy for inflammatory bowel disease in pregnancy and the puerperium. Best Pract Res Clin Gastroenterol 2007; 21:835-47. [PMID: 17889811 DOI: 10.1016/j.bpg.2007.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Inflammatory bowel disease (IBD) has a peak age of onset in the 3rd decade and a peak prevalent age in the fourth decade in most studies. As a result many patients affected by Crohn's disease and ulcerative colitis are females of reproductive age interested in bearing children. It has been shown that the most important factor in the success of a pregnancy in patients with IBD is the state of disease activity. Therefore, the goal prior to and during pregnancy is to best optimise control of the disease through medical therapy. Unfortunately, many medications utilised to treat IBD are potentially toxic and/or teratogenic, leaving many physicians and patients without a clear answer as to the safest methods of therapy. This review attempts to summarise the medical literature to date, as it pertains to the safety of medical therapy for IBD during pregnancy and the puerperium.
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Affiliation(s)
- Dana C Moffatt
- University of Manitoba, Department of Internal Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada.
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24
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Abstract
Constipation is a common symptom during pregnancy. The majority of cases are simple constipation that occurs due to a combination of hormonal and mechanical factors affecting normal GI function. However, a number of women suffer from constipation prior to conception and find their symptoms worsen during pregnancy. Patients with simple constipation can usually be treated by explanation, reassurance and advice. Medications are best avoided but if necessary should be taken under supervision using best available evidence. It is important that all patients be evaluated by detailed history, physical examination and basic investigations to outrule GI pathology that may be present in a small number of cases. Those whose symptoms predated their pregnancy should be fully evaluated after the puerperium.
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25
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Abstract
Inflammatory bowel disease (IBD) is a disease that affects women of childbearing age. Active disease at conception increases the risk for adverse outcomes and thus postponement of pregnancy until the disease is in remission is the best advice that physicians can give their IBD patients. The majority of medications used to treat IBD are safe in pregnancy and breastfeeding; active, untreated, or undertreated disease is more deleterious than active therapy.
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Affiliation(s)
- Joyann Kroser
- Clinical Associate Professor of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19107, USA
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26
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Derbyshire E, Davies J, Costarelli V, Dettmar P. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. MATERNAL & CHILD NUTRITION 2006; 2:127-34. [PMID: 16881925 PMCID: PMC6860573 DOI: 10.1111/j.1740-8709.2006.00061.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Few studies appear to have investigated the prevalence of constipation for all three trimesters of the gestative period, or indeed after birth. Using a prospective 4- to 7-day weighed food diary, International Physical Activity Questionnaire and 7-day bowel habit diary, dietary factors, physical activity levels and bowel habit parameters were assessed and examined concurrently at weeks 13, 25, 35 of pregnancy and 6 weeks post-partum. Ninety-four primiparous pregnant women were initially recruited, and 72, 59, 62 and 55 completed the first, second, third trimester and post-partum study stages, respectively. Key dietary factors and physical activity levels were compared between the constipated and non-constipated groups from each of the three trimesters and after parturition. Compared with non-constipated mothers-to-be, constipated participants consumed statistically significantly less water in the first trimester (P = 0.04), more food in the second trimester (P = 0.04), and less iron (P = 0.02) and food (P = 0.04) in the third trimester and after birth, respectively. No statistically significant differences were identified between light, moderate and vigorous physical activity levels when groups were compared. This study demonstrates that dietary factors may play a role in terms of preventing, or alleviating, bowel habit perturbations both throughout and after pregnancy. Further research is required to investigate the interrelationship between physical activity and constipation during and after pregnancy.
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Affiliation(s)
- Emma Derbyshire
- Academy of Sport, Physical Activity and Well-being, London South Bank University, London, UK.
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27
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Thukral C, Wolf JL. Therapy Insight: drugs for gastrointestinal disorders in pregnant women. ACTA ACUST UNITED AC 2006; 3:256-66. [PMID: 16673005 DOI: 10.1038/ncpgasthep0452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 02/01/2006] [Indexed: 12/20/2022]
Abstract
The management and treatment of gastrointestinal ailments in pregnant women requires special attention and expertise, since the safety of the mother, fetus and neonate remains the primary focus. Nausea and vomiting during pregnancy is common, as is symptomatic gastroesophageal reflux disease. Peptic ulcer disease occurs less frequently and with fewer complications. Gastroenterologists and obstetricians should be familiar with safe treatment options for these conditions, because they can profoundly impair the quality of life of pregnant women. During pregnancy, constipation can develop de novo, or chronic constipation can increase in severity. Given the array of therapies for constipation, physicians must apprise themselves of drugs that are safe for both mother and fetus. Management of acute, self-limited diarrhea should focus on supportive therapy, dietary changes and maintenance of hydration. Treatment of chronic diarrhea should be considered in the context of therapy for the underlying disorder. Inflammatory bowel disease and irritable bowel syndrome present a unique therapeutic challenge--to control the disease while minimizing toxicity to the fetus and mother. Initiation and alteration of medical therapy for gastrointestinal disorders during pregnancy must be undertaken after discussion with the patient's obstetrician.
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Affiliation(s)
- Chandrashekhar Thukral
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA 02215, USA
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28
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIVERORDNUNG IN SCHWANGERSCHAFT UND STILLZEIT 2006. [PMCID: PMC7271219 DOI: 10.1016/b978-343721332-8.50004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Abstract
Fertility is affected in ulcerative colitis after surgery and in active Crohn's disease. Adverse fetal outcomes are not increased when IBD is quiescent. Active disease at conception increases the risk of adverse fetal outcomes. Most medications for IBD are safe during pregnancy and breastfeeding, with notable exceptions. Active disease is usually more deleterious than maintaining medical therapy.
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Affiliation(s)
- Sunanda Kane
- Division of Gastroenterology, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637, USA.
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30
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Abstract
Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.
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Affiliation(s)
- Arnold Wald
- University of Pittsburgh Medical Center, Division of Gastroenterology, Hepatology and Nutrition, PUH, Mezzanine Level, C-Wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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31
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Kaiser LL, Allen L. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:1479-90. [PMID: 12396171 DOI: 10.1016/s0002-8223(02)90327-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is the position of the American Dietetic Association that women of childbearing potential should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; consumption of a variety of foods in accordance with the Food Guide Pyramid; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food-handling. Prenatal weight gain within the Institute of Medicine (IOM) recommended ranges is associated with better pregnancy outcomes. The total energy needs during pregnancy range between 2,500 to 2,700 kcal a day for most women, but prepregnancy body mass index, rate of weight gain, maternal age, and physiological appetite must be considered in tailoring this recommendation to the individual. The consumption of more food to meet energy needs and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This statement also includes recommendations pertaining to use of alcohol, tobacco, caffeine, street drugs, and other substances during pregnancy; food safety; and management of common complaints during pregnancy and specific health problems. In particular for medical nutrition therapy, pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria (PKU), certain chronic health problems, or a history of substance abuse should be referred to a qualified dietetics professional.
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Abstract
Most women with inflammatory bowel disease who desire to become pregnant can expect to conceive successfully, carry to term, and deliver a healthy infant. However, the management of inflammatory bowel disease during pregnancy remains challenging, and some women with ulcerative colitis or Crohn's disease will have difficulty becoming pregnant or have increased disease symptoms while pregnant. Control of disease activity before conception and during pregnancy is critical to optimize both maternal and fetal health. The natural history of inflammatory bowel disease during pregnancy will be reviewed and the medical and surgical therapy discussed.
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Affiliation(s)
- J A Katz
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Tosal Herrero B, Richart Martínez M, Luque Plaza M, Gutiérrez L, Pastor García R, Cabrero García J, Reig Ferrer A. [Gastrointestinal signs and symptoms during pregnancy and postpartum in a sample of Spanish women]. Aten Primaria 2001; 28:53-8. [PMID: 11412579 PMCID: PMC7681671 DOI: 10.1016/s0212-6567(01)78896-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the evolution of the signs and more frequent gastrointestinal symptoms during the pregnancy and in the two weeks later the birth. METHODS SUBJECTS 583 pregnant women, elects in an accidental way, interviewees between the 8 and 12 weeks of gestation (n = 133), among 18 and 22 (n = 155), among 37 and 42 (n = 203) and two weeks after the childbirth (n = 92) and coming from centers of health and hospitals of the Comunidad Valenciana and Murcia. The questionnaire, answered in a voluntary way by interview, it contained a listing on the signs and more frequent gastrointestinal symptoms during the pregnancy, and she answered on the presence or not of the same ones in the two weeks previous to the moment of the interview. RESULTS The percentage of nauseas and vomits, although higher in the first trimester, stays around the 25-30% in the third gestation trimester. The heartburn is presented in 58.6% of the pregnant women in the third trimester. The sialorrea is presented in 7.7% of all the pregnant women and she stays during the whole gestation. The constipation stays constant during the gestation above at the 25-30%. The prevalence of haemorrhoids to the beginning of the gestation is over to 8% to be located in the postpartum in 53.3%. CONCLUSIONS The description of the evolution of the signs and symptoms of the pregnancy described in the obstetrics manuals don't come up with our data.
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Affiliation(s)
- B Tosal Herrero
- Centros de Salud Archena y Santomera (Murcia). Hospital Universitario San Juan. San Juan (Alicante). y Departamentos de Enfermería y Psicología de la Salud de la Universidad de Alicante.
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34
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Abstract
Pregnancy often exacerbates constipation in young women with chronic constipation syndromes. The presence of the fetus presents a challenge in both the diagnosis and treatment of these syndromes. This study was conducted to report a rare case of idiopathic megarectum complicating a pregnancy. An aggressive polyethylene glycol (PEG) regimen allowed the patient to carry the child to term and to have a normal vaginal delivery. Successful proctocolectomy was performed with coloanal anastomosis 3 months postpartum. The patient has been free of constipation for 18 months without the need for cathartics or laxatives. All efforts to avoid operative intervention should be made in constipated patients during pregnancy. This principle holds true even in the setting of dilated large bowel. Idiopathic megarectum and the management of constipation in pregnancy are discussed.
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Affiliation(s)
- E M Grossmann
- Department of Surgery, Saint Louis University School of Medicine and Health Sciences Center, Missouri, USA
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