Pica

Description

Pregnancy can bring about a whole bunch of wonderful experiences, but also some very weird ones. A food craving, or the desire for specific food or food combinations, is one of the best known phenomena.

The cause is a mystery and there is no evidence that cravings are the result of nutritional deficiencies. Some feel it may be a hormonal or emotional response.

Some common cravings include chocolate, sweets, citrus fruits and juice, cheese, and grain products. If the food you crave is nutritious, there is no harm in satisfying the craving (within reason). If it is in the "nice but not necessary" category, such as sweets, cookies, cakes, and chips, try eating it small amounts along with a healthy meal or snack.

Pica is the Latin word for the magpie, a bird which eats or carries away odd objects. Some pregnant women crave unusual food items or non-food items. This is called pica. Eating these items can be dangerous to both the mother and the baby, or interfere with adequate nutrient intake. If you experience these types of cravings, consult your doctor.

Alternative names

citta / cissa / cittosis

What is Pica?

Pica is an eating disorder (acute craving) typically defined as the persistent eating of non-nutritive (non-food) substances. The definition occasionally is broadened to include the mouthing of non-nutritive (non-food) substances.
Women with pica have been reported to mouth and/or ingest a wide variety of non-food substances, including, but not limited to:

• Ice (pagophagia)
   
• Dirt (geophagia)
   
• Vinyl gloves
   
• Needles
   
• String
   
• Pencil erasers
   
• Light bulbs
   
• Gravel
   
• Flaking paint or plaster
   
• Laundry starch (amylophagia)
   
• Coal
   
• Cigarette ashes
   
• Clay
   
• Rocks
   
• Chalk
   
• Hair
   
• Glue

Most frequently, pica occurs in women before or during their pregnancies or while they are breastfeeding, but it is not limited to them: it can manifest in all adults and even in small children, especially among children who are developmentally disabled.

What causes pica?

The exact cause is not known. It could be one of, or the combination of, different conditions / factors like:

• Deficiencies in iron, calcium, zinc, and other nutrients (like thiamine, niacin, vitamins C and D). However, the non-food items craved usually do not supply the minerals lacking in the person's body.
   
• Mental or physical illness
   
• Malnutrition and hunger due to an eating disorder or poverty.
   
• Women who experienced pica in childhood.

Symptoms

Primarily, persistent eating of non-nutritive (non-food) substances for a period of at least a month. Other signs and symptoms may include:

• Loss of appetite
• Abdominal pain
• Constipation
• Diarrhoea
• Recurrent infections and/or parasitic infestations
• Dental injuries

 Diagnosis

• Depending on the degree of pica displayed, the condition could be difficult to identify in pregnant women.
   
• If a woman eats easy digestibly substances in small quantities it might not be detected by the doctor as she might be too embarrassed to discuss it.
   
• The patient may not show signs of malnutrition if she is eating an otherwise balanced diet.
   
• In more serious cases, Pica could be diagnosed if the patient has intestinal blockages, shows signs of poisoning (lead or other), and through X-rays
   
• There is no specific medical test that can confirm pica.
   
• Before making a diagnosis, the doctor will rule out any mental disorders.
   
• Pica in pregnant women is sometimes only diagnosed after childbirth because of a health problem in the newborn caused by the substance(s) ingested by the mother.

Risks
 

Malnutrition or poisoning of mother and foetus is the most obvious risk. Others include:

• Intestinal infections or parasites from soil
   
• Intestinal obstruction / bowel perforation
   
• Anaemia
   
• Liver and kidney damage
   
• Constipation and abdominal problems

Treatment

This will often depend on the cause and degree of pica. Supplementation with iron-containing vitamins has been shown to cause the unusual cravings to subside in some iron-deficient patients.

Prognosis

This is generally favourable, especially with early treatment. Pica that develops during pregnancy usually resolves on its own once the mother gives birth.

When do you call the doctor?
 

• If you have acute and chronic cravings for any non-food substances during pregnancy you should tell your doctor; and
   
• If you have eaten non-food substances and you experience abdominal pain or severe constipation, you should call your doctor immediately.

 How can pica be prevented?
 

• Eat a healthy diet that includes a variety of fresh fruits and vegetables, and an adequate amount of protein and carbohydrates.
   
• Take a daily prenatal vitamin.
   
• If you cannot stomach prenatal vitamins due to morning sickness, try taking a regular multivitamin along with a folic acid supplement.
• Visit your doctor during all scheduled antenatal visits.