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Implications and Risks Associated with PICA During Pregnancy

Erin Jacoby and Brittany Wynn

INTRODUCTION

Embyotic Development & Geophagia

SUMMARY

Material consumption of soil, clay or other earth material can be detrimental to
both the mother and her unborn infant. It is important to understand the risks
associated with geophagia. Below is a research study (Reeuwijk 2013) that
focused on the dioxins that are commonly found in earth made material.
• Certain clays contain high concentrations of polychlorinated dibenzo-pdioxins and dibenzofurans (PCDD/F’s)
• Frequent consumption of clay or soil with high concentrations of dioxins may
result in:
• Increased exposure to the mother and fetus
• Reproductive and/or developmental problems
• Damage the immune system
• Interfere with hormones
• Liver function
• Decreased test performance
• May cause or trigger cancer

In summary, pica is an ongoing concern worldwide that carries numerous risks.
Different forms of pica can be dangerous to one’s health or even life-threatening.
Listed below are several health concerns that can be detrimental to the mother
and unborn infant.

Pica, which is commonly associated with pregnancy, is the impulsive and routine
ingestion of unsustainable items [1]. Frequently consumed non-food items would
include clay, rocks, ice, soap, chalk, and other potentially harmful objects. There
are sevral types of pica, which include geophagia, pagophagia, and amylophagia.
Geophagia is the injestion of earth materials, pagophagia is ice consumption, and
amylophagia is the oral intake of starches. Experiencing pica during pregnancy can
be an indicator of nutrient deficiencies, especially specific minerals that pregnant
women need. Common nutrient deficiencies that are commonly associated with pica
include iron, zinc, and magnesium.

RESEARCH

Studies have found a multitude of negative consequences or side effects from
partaking in behaviors associated with pica





Abdominal pain1, constipation intestinal obstruction3
Infection1, parasitoses 3
Lead poisoning, hyperkalemia, phosphorus intoxication, toxoplasmosis3,4
Low bone mineralization4
Dental injury4
Significantly lower head circumference of neonate5

Several studies have recorded common reasons women reported eating behaviors
related to pica
• Maternal hemoglobin concentrations lower in women with pica than nonpica women3,5
• Similar age, pre-pregnancy BMI, parity, neonatal birth weight, and
gestational age in both pica and non-pica women5
• Significantly smaller head circumferences in neonates of pica mothers
than non-pica mothers5
• A strong relationship was determined between geophagy, amylophagy, and
low hemoglobin concentrations and iron deficiency anemia2
Pregnant women are at a higher risk of pica due to increased nutrient needs, food
cravings/aversions, and other side effect of pregnancy that can affect nutrient
status. There are different methods that can be done to improve health and
nutrition of those at risk for pica:
• A large amount of nausea and vomiting is experienced by pregnant women
that could affect the dietary intake1
• Food cravings and aversions are related to the maternal dietary intake so
it is important to understand these when looking at maternal nutrition1
• Iron nutritional status should be assessed due to the lower hemoglobin
levels in women with pica. Iron supplements have been proposed to
reverse pica3
• Dietitians should ask pregnant women with anemia about pica and counsel
pregnant women who report having pica5
• The early diagnosis of pica would contribute to identifying the pregnant
women at increased risk for iron deficiency5

Prevalence of Different Types of Pica6
100%

Geophagy

90%

Population Prevalence

The research states that there are many causes for pica during pregnancy along with
many possible causes associated with them. Pica, however, is a poorly understood
compulsion to persistenly consume non-nutritional substances with little or no
nutritional value. Research finds that the etiology of pica is poorly understood but
some possible causes are1
• Hunger2
• Psychological Stress3
• Micronutrient deficiencies (Fe, Zn, and Ca) and iron deficient anemia2
• Cultural traditions1
• Low hemoglobin concentrations2
• Gastrointestinal distress2

Amylophagy

Other non-foods

80%











Iron deficient anemia
Damage to the immune system
Hormone interference
Lead poisoning
Dental/mouth injuries
Constipation
Nutrient deficiencies
Choking
Bowel Blockage
Poisoning
Infant stillbirth

PICA
When what you crave is not fit
for human consumption

More research is needed in order to better understand what the cause of pica is
and what can be done to reduce the prevalence of pica, especially during
pregnancy. There are currently only behavioral modifications or treatment
methods available, which will later be discussed, that can help manage pica.
However, there has yet to be any specific medication that can be taken to
prevent or help reduce the risks associated with pica during pregnancy.

70%
60%

CLINICAL APPLICATION

50%
40%
30%
20%
10%
0%
Male
(n=217)

Female Male Female
Male
(n=258) (n=16) (n=25) (n=160)

Children
(5-11 years)

Adolescents
(12-16 years)

Female Lactating Pregnant
(n=84) (n=22)
(n=4)

Adults
(>16 years)

Perinatal
Female

Iron Deficient Anemia
It is recommended that women ages 19-50 consume 18mg of iron whereas
pregnant women ages 19-50 are recommended to consume 27mg of iron. Listed
below is a brief overview of a study that focused on iron consumption and anemia
in pregnant women suffering from pica and the chart represents the population
prevalence of pica.
• Cross-sectional study to collect socioeconomic characteristics, food
intake, geophagy, amylophagy, anthropometry, iron status, parasitic
burden, and gastrointestinal morbidities.
• 36.3% reported amylophagy while 5.2% geophagy, and any other
additional pica was 40.1%.
• A strong relationship was determined between geophagy and/or
amylophagy with iron deficiency anemia.
• Several proposed etiologies of pica: hunger, micronutrient deficiencies,
gastrointestinal distress, and increased exposure to pathogens and
toxins.

Prevention – listed below are several pica prevention methods.

Recommend healthy balanced diet to patients

Include pica education in prenatal care

If low iron levels are apparent in a patient consider iron
supplementation

Educate patient on good sources of heme and non-heme iron
Treatment – while there is not currently a drug or medication that can cure pica
there are several methods listed below to help treat it

Behavior modification

Possible iron supplementation

Education on proper nutrition for a healthy pregnancy and
sources of iron

Inform patient on negative outcomes from pica

Harmful side effects to infant can be preventable

Food
Mollusks – clams, mussels, oysters
Liver – chicken, beef, turkey, lamb, pork

Iron
24mg/3oz
26mg/4oz

Squash/Pumpkin Seeds
Nuts
Beef/Lamb
Beans & Lentils
Whole Grains, Cereals, Brans
Dark Leafy Greens
Dark Chocolate
Tofu

34mg/1cup
7.8mg/1cup
3.1mg/3oz
6.6mg/1cup
2.8mg/1cup
6mg/1cup cooked
5mg/square
3.4mg/1cup