Pica during pregnancy in low-income women born in Mexico

Abstract

ⅷ Objective To describe pica behavior (ingestion of nonfood items) in pregnant low-income Mexican-born women in Mexico and the United States. ⅷ Design A convenience sample of informants was interviewed with a questionnaire containing open-ended and closed-ended questions. ⅷ Setting A low-income community on the outskirts of Ensenada, Mexico, and clinics serving low-income people in southern California (Santa Ana, Bakersfield, and Los Angeles). ⅷ Participants Of a total of 225 Mexican-born women, 75 (33%) were interviewed in Ensenada, and 150 (67%) were interviewed in southern California. ⅷ Results The prevalence of pica during pregnancy was 44% (n = 33) in the Ensenada group and 31% (n = 46) in the southern California group. Those who reported pica behavior more commonly had a relative who also practiced pica. ⅷ Conclusion The high reported rate of pica in this sample indicates that pregnant Mexicanborn women should be screened for pica and educated about the potentially serious effects on the fetus and mother.BACKGROUND Pica-the ingestion of nonfood items-has aroused the curiosity of medical personnel since at least the 16th century. 1 Pica in children has been studied extensively, but pica during pregnancy remains understudied and underreported. Recent articles exploring the practice 1-4 have been contradictory and present little conclusive evidence about its cause and prevalence. Pica during pregnancy is a worldwide phenomenon, 5-8 but in the United States it has been studied largely in the South, with an occasional report from the Midwest. Although this behavior is known to occur in pregnant Latina immigrants in the Los Angeles area, 9 there are no detailed descriptions of the practice in Mexican-born women either in the United States or in Mexico.The prevalence of pica in pregnant women has been reported from as low as 0% to as high as 68% in the various groups studied. 10 In general, pica behavior is probably underreported because the ingestion of nonfood items may be seen as either shameful or merely unimportant and "normal." 4 Suggested risk factors also vary between studies. A meta-analysis of dirt-, clay-, and starch-eating women found that race was the major risk factor for pica during pregnancy: it was 4 times higher in black women than in white women. 3 A study by Edwards et al, 11 however, found no significant racial difference in the prevalence of pica in a rural obstetric population; instead, a childhood, family, and nonpregnant history of pica behavior played a role. The meta-analysis also indicated that rural women were twice as likely as urban residents to exhibit pica and that lower socioeconomic status, greater maternal age, impaired nutritional status, and a childhood or family history of pica were additional risk factors. 3

Lead Poisoning Among Pregnant Women in New York City: Risk Factors and Screening Practices

“…Pica during pregnancy has been previously documented in both rural and urban parts of the United States, with one study of Mexican American women living in California reporting a 31% prevalence. 22,23 The specific risk factors identified here are consistent with a recent study of predominantly Latino pregnant women in South Central Los Angeles, which found that pica and recent immigration to the United States (as well as low calcium intake) were the strongest predictors of BLLs. 24 There was also some tendency for higher BLLs to be associated with younger maternal age, more advanced EGA, and more recent immigration to the United States.…”

A cross-sectional analytical study of geophagia practices and blood metal concentrations in pregnant women in Johannesburg, South Africa

“…It appears to be more common in children than in adults, in women than in men, in black people than in white people, in rural areas than in urban areas, and in pregnant women than in non-pregnant women. [4] Pregnant women have been identified as a group in which geophagia is particularly widespread, and studies undertaken in Dar es Salaam (Tanzania) and Nairobi (Kenya) showed prevalences of 64% and 74%, respectively. [5,6] Few studies have described the practice of pica and geophagia in South Africa (SA).…”

“…[11] While strongly held beliefs about the nutritional benefits and detoxifying effects of geophagia exist, [12] ingestion of soil has been shown to interfere with the bioavailability of micronutrients (leading to micronutrient deficiencies), and may result in geohelminthic infec tions, anaemia, hypokalaemia, peritoneal mesothelioma and intestinal obstruction or perforation. [2,4,8] Geo phagic behaviour may also increase exposure to metal contaminants in the soil, including arsenic and lead -for example, elevated concentrations of arsenic were found in the baked clay (sikor) widely con sumed by pregnant Bangladeshi women in the UK. [3] A study in New York found women who practised pica to have higher blood lead levels than other women.…”

Pica in the Pregnancy and Related Psychological Aspects

“…Studies suggest that there are important emotional aspects associated with pica, and this disorder is most often studied in pregnant women because of the risks to baby (Ahmed et al, 2012;Simpson, Mull, Longley, & East, 2000;Thihalolipavan et al, 2013). Inappropriate substances consumed, often toxic (eg.…”

“…The increasing on synthesis of female hormones could causes mother's body changes and affects the fetal development (Vieira & Parizotto, 2013). These hormonal changes may cause signifi cant physical and psychological changes in women, and result in depressive symptoms, anxiety, poor concentration, irritability, changes in appetite, insomnia, hypersomnia and loss of energy (Vieira & Parizoto, 2013;Simpson et al, 2000).…”