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

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This survey adds to the body of knowledge that indicates a lack of AMS knowledge among travelers. In addition, this survey identifies 2 potential avenues for improved dispersal of information: 1) guidebooks for countries of concern and 2) national health agency Web sites linked to information on pretravel vaccinations. Recommendations are made to utilize these commonly accessed resources to increase AMS information distribution to the general populous.

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