13 These symptoms presented during the last 2 pregnancies. One case report described a 26-year old female presenting with consumption of uncooked rice and wheat that started during her third pregnancy and continued postpartum. The evidence for pharmacologic treatment of pica during pregnancy remains limited. The guidance notes that parenteral iron may improve hemoglobin levels faster compared with oral iron, but by day 40, both formulations correct hemoglobin to a similar level. Parenteral iron is reserved for patients with intolerance to oral iron, malabsorption syndrome, or severe iron deficiency anemia. 12 Women with iron deficiency anemia should receive supplemental iron, preferably oral. The 2008 American College of Obstetricians and Gynecologists guideline on anemia in pregnancy recommends screening all pregnant women for anemia. Patients with malabsorption issues would also benefit from parenteral iron. The authors urged to screen all pregnant women for pica and consider using parenteral iron formulation to rapidly replenish iron stores in pregnant women near term. This case illustrates that deficient iron stores may drive pica behavior. 10 The cravings fully resolved at 36 h post-administration. A more recent case report described administering 1 dose of intravenous iron dextran to a pregnant woman with iron deficiency and cravings for bar soap and laundry detergent. The case did not specify the formulation, dosing, or frequency of iron therapy. 11 The patient, who was not pregnant at the time of treatment, received iron therapy leading to the resolution of pagophagia at 1 month. In 1 case, a patient developed pagophagia during pregnancy that continued for 4 years postpartum the laboratory work-up revealed iron deficiency. Two case reports described the effects of managing iron deficiency anemia in patients with pica that developed during pregnancy (Table 1). Treatment of iron deficiency anemia can resolve pica. 10 Case reports explored additional pharmacological treatments for persisting pica. 3 Women with iron deficiency anemia require iron supplementation as the evidence reveals a positive correlation between anemia and pica. Typical treatment for pica involves counseling and assessment for other psychiatric disorders, but some patients may require pharmacologic interventions. 8 On the contrary, another study showed a lack of pregnancy complications in women with pica. 7 And a more recent study found that pica may affect birth weights of infants. A study revealed that head circumferences of infants born to women struggling with ingestion of large quantities of ice and/or freezer frost were smaller compared with infants born to women without pica. 6 The effects of pica on the fetus remain unclear. A meta-analysis of 43 studies revealed that pica contributes to developing anemia and lowering hemoglobin, hematocrit, and/or zinc levels. Ingestion of soil could lead to nutritional deficiencies and intestinal parasite infection, while ingestion of ice lacks notable complications. 3 Ingestion of clay may cause nutritional deficiencies, constipation, and/or gastrointestinal obstruction or perforation. 2,3Ĭomplications of pica depend on the ingested substance and its amount. 2 Other risk factors for developing pica include lower educational status, residence in rural areas, and culture (eg, women in Kenya consume clay due to its perceived role in fertility and reproduction). 3,5 A meta-analysis of 70 studies revealed that women with anemia are 1.6 times more likely to develop pica compared with women without anemia and that patients of African American ethnicity are 2.2 times more likely to have pica compared with other ethnicities. 3 One theory suggests that deficiencies in minerals such as iron or zinc contribute to pica, while others propose that practicing pica interferes with micronutrient absorption and leads to these deficiencies. Cravings for substances such as cigarette ashes, burnt matches, stones, coffee grounds, paint chips, or sand may occur.Īlthough the causes of pica in pregnancy are unclear, certain risk factors predispose pregnant women to developing this condition. 3 Most common cravings consist of clay or dirt (geophagia), large amounts of ice (pagophagia), or raw starch (amylophagia). 2-4 The prevalence numbers may be underreported because many pregnant women feel uncomfortable reporting the condition. 1 Pica occurs more frequently during pregnancy – close to 30% of pregnant or postpartum women experience pica worldwide, with the highest prevalence in Africa. According to the 5 th edition of the Diagnostic and Statistical Manual of Mental Disorders, pica is a condition involving persistent eating of nonfood substances for over at least 1 month that is not part of cultural or social practice.
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