Pica in a Rural Obstetric Population

Smulian, John C.; Motiwala, Shabbir; Sigman, R. K.

doi:10.1097/00007611-199512000-00010

Cited by 45 publications

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“…23,42 However, in prior population-level studies, the relationship between amylophagy and anemia in pregnant women has been less consistent. 41,42,51 The correlates of pica may offer some insight into the posited etiologies of pica: hunger, micronutrient deficiency, gastrointestinal distress and protection from pathogens and toxins. Predicted means of ( A ) hemoglobin and ( B ) zinc protoporphyrin (ZPP) and ( C ) proportion with iron deficiency anemia (IDA) for mean gestational age and having no hookworm or malaria infection by pica behavior at any point in pregnancy and at time of baseline interview, Zanzibar, Tanzania.…”

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confidence: 99%

Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania

Young

Khalfan

Farag

et al. 2010

The American Society of Tropical Medicine and Hygiene

103

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* Indicates significance of difference by t -tests between no pica and any pica groups. † Values are mean (SD). 147PICA, ANEMIA, AND GI DISTRESS IN ZANZIBAR, TANZANIA The prevalence of IDA followed a similar pattern, with the prevalence of IDA significantly higher among amylophagists than among those who reported no pica at any point in pregnancy (52.6% versus 36.1%; P < 0.001) and highest among women who ate both pica substances (57.0% versus 36.1%; P < 0.001) ( Figure 2 ). The effect of uncooked rice and earth on iron status was independent; there was no evidence of interaction between the two types of pica behavior on Hb or ZPP.A significantly higher proportion of women who had eaten earth in the current pregnancy had experienced abdominal pain and constipation than non-geophagic women ( Table 4 ). A significantly higher proportion of pregnant women who had consumed uncooked rice at some point in the current pregnancy had experienced nausea and abdominal pain than those who had not. More women who had engaged in any form of pica had experienced nausea, abdominal pain, and constipation in this pregnancy than those who had not. There were no significant differences in loss of appetite, diarrhea, or vomiting between the pica versus non-pica group.Statistical models of pica. We built a multivariate logistic regression model of any pica to examine the relative strength of the association of the correlates of pica when considered jointly ( Table 5 ). Hookworm was not included for three reasons: it greatly limited the sample size, the effects of hookworm on iron status are largely captured by the inclusion of Hb, and we have already established that geophagy is not a vector for hookworm transmission in this population. 15Women with lower Hb concentrations, women who were later in gestation, and women who had experienced abdominal pain or nausea were more likely to engage in pica. Older women and women whose husbands had received formal education were less likely to engage in pica. The variable with the strongest association with any pica was nausea (OR = 1.45, 95% CI = 1.20-1.73), followed by Hb. For every g/dL decrease in Hb concentration, the likelihood of engaging in pica increased by 31.5% (OR = 0.76, 95% CI = 0.73-0.81).We then examined how the predictors of any pica determined geophagy and amylophagy separately ( Table 5 ). The ORs in logistic models of geophagy and amylophagy separately were consistently in the same direction and of similar magnitude as they were for any pica. DISCUSSIONOf the 2,367 pregnant women, 897 (37.9%) had engaged in geophagy by the time of their enrollment into the larger study of the prevention of severe anemia in pregnancy. Of these, 36.3% were amylophagists, 5.2% were geophagists, and 3.6% had eaten raw rice and earth.The prevalence of geophagy among pregnant women in Africa has been reported to range from 28% to 100% [31][32][33][34][35][36][37][38][39][40] ; the prevalence on Pemba Island was markedly lower (5.2%). However, the amounts of earth consumed in Pemba (26.5 grams/day)...

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confidence: 99%

Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania

Young

Khalfan

Farag

et al. 2010

The American Society of Tropical Medicine and Hygiene

103

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“…4 Ingestion of matches during pregnancy dates back decades, but literature thoroughly describing cautopyreiophagia is scarce. [5][6][7] In the United States, commercially available matchsticks contain sulfur, potassium…”

Section: Discussionmentioning

confidence: 99%

Maternal Cautopyreiophagia as a Rare Cause of Neonatal Hemolysis: A Case Report

et al. 2015

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Hyperbilirubinemia in the first 24 hours of life in a newborn is pathologic, necessitating additional evaluation. We report the first case of hemolysis and subsequent hyperbilirubinemia in an otherwise normal term neonate resulting from oxidative stress in the form of maternal cautopyreiophagia: the ingestion of burnt matchstick heads. During the third trimester of pregnancy, the infant's mother consumed more than 300 burnt matchstick heads weekly for 4 weeks. Matches contain potassium chlorate, a powerful oxidant that when ingested can ultimately lead to the destruction of erythrocytes, disseminated intravascular coagulation, kidney injury, or death. The infant's bilirubin rose as high as 17 mg/dL at 22 hours of life; however, the infant did well with a brief course of phototherapy. This case highlights the importance of prenatal questioning about maternal ingestion of potentially oxidative substances and assessing the possible risk for the infant.

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“…[21][22][23] Smulian and colleagues interviewed 125 pregnant women in rural Georgia and found that 14% reported pica behavior. 22 A study of pregnant, low-income, Mexican-born women found that pica behavior was reported by 44% of those interviewed at a clinic in Mexico and by 31% of those interviewed at a clinic in southern California. 24 It is likely that pica is underreported by women because of embarrassment and shame.…”

Section: Sources Of Lead Exposurementioning

confidence: 99%

Lead Hazards for Pregnant Women and Children: Part 1

Cleveland¹,

Minter²,

Cobb

et al. 2008

AJN, American Journal of Nursing

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Poor, urban, and immigrant populations are at far greater risk for lead exposure than are other groups in the United States. Children with even slightly elevated blood lead levels are at increased risk for significant neurobehavioral problems that can extend through adolescence. Research has shown that elevated blood lead levels in pregnant women, even those well below 10 micrograms per deciliter-the Centers for Disease Control and Prevention's "level of concern"-can cause miscarriage, premature birth, low birth weight, and subsequent developmental delays in their children. Despite these well-established dangers, routine prenatal lead screening and lead education is not a standard of care. Part 1 of this two-part article presents a short case example of a pregnant mother with lead poisoning and describes the epidemiology of lead exposure in the United States, the main sources of lead exposure, and the effects of lead on the pregnant mother and the developing fetus and child. Prevention is crucial. Treatment options such as chelation must be used selectively and will not reverse damage once it's occurred. Part 2 will describe recommendations for screening, education, nutrition, reducing environmental exposures, and treatment.

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Pica in a Rural Obstetric Population

Cited by 45 publications

References 0 publications

Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania

Association of Pica with Anemia and Gastrointestinal Distress among Pregnant Women in Zanzibar, Tanzania

Maternal Cautopyreiophagia as a Rare Cause of Neonatal Hemolysis: A Case Report

Lead Hazards for Pregnant Women and Children: Part 1

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