INFORMATION FOR WOMEN WHO HAVE PICA DURING PREGNANCY OR BREASTFEEDING
What is pica during pregnancy?
Pica is a category of eating disorder characterized by a craving for, and compulsive consumption of, things that are not usually considered edible or nutritious. Various subtypes of pica all have names with the suffix phagia (Greek for eat/eating), following a particular prefix referring to the type of non-food substance that the person eats. Examples include geophagia (eating clay or dirt, sometimes called chthonophagia), lithophagia (eating stones/gravel), trichophagia (eating hair), geomelophagia (eating raw potatoes, more than just a small slice that you might sample as part of a nature activity in summer camp), pagophagia (eating ice, more than just the ice remaining in your beverage on a hot day), amylophagia (eating starch, not just a loaf of bread, but purified starch, such as flour or corn starch, in high amounts), cautopyreiophagia (eating burned matches). Other items that people may consume include coffee grounds, plants, paper, soap, baking soda, and paint chips.
To qualify as pica, the behavior must be out of sync with practices of the persons culture. In children, it also must be inappropriate to the age/level of development of the individual, but this requirement doesnt apply to pregnant women. The behavior also must occur for at least one month and cannot be the result of a behavioral disorder, such as autism spectrum disorder, or a psychotic disorder. Technically, the behavior also does not qualify as pica, if it develops in the setting of a known medical condition, including pregnancy (which often produces odd cravings). However, you can suffer from pica resulting from another medical condition overlapping with pregnancy. The key example of this is iron deficiency, which can cause pagophagia (ice munching) and other forms of pica, and which can develop, particularly if you are borderline anemic prior to getting pregnant. Thus, when cravings during pregnancy reach the point of including non-food substances, it is likely that you are suffering from pica.
How common is pica during pregnancy?
A meta-analysis (combined statistical analysis of multiple studies) of 70 published studies suggests that some form of pica affects as much as 27.8 percent of pregnancies worldwide, with a disproportionately high number of cases in Africa. Other studies have reported pica occurring at rates as high as 44 percent in low-income Latina pregnant women of southern California and certain other populations as high as 68 percent. Various explanations have been proposed, but there is no clear answer as to the cause of pica in so many women. However, doctors and researchers do know that anemia and lower educational level are major factors elevating the risk of developing pica.
How is pica during pregnancy diagnosed?
Pica is diagnosed considering a patients history and speaking with family members and assessing whether she meets pica diagnostic criteria, such as those listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). To qualify as pica, the eating of non-food substances must be out of sync with practices of the persons culture and it must occur for at least one month. It cannot be the result of a behavioral disorder, such as autism spectrum disorder, or a psychotic disorder. In the case of pregnancy, generally, pica would be recognized after you are found to have a problem underlying pica, such as iron deficiency, or some type of toxicity (poisoning) or intestinal obstruction, developing as a complication of pica. Depending on the nature of the substances that you are ingesting, various diagnostic procedures will be needed that may include imaging to assess damage to the intestinal tract and internal organs. Testing will also include blood tests, such as a complete blood count (CBC) and iron studies to evaluate anemia and iron deficiency, a comprehensive metabolic panel (CMP), and tests for levels of lead and other toxins.
Does pica cause problems during pregnancy?
Depending on the type of pica, a range of complications can develop, including toxicity from excessive intake of particular chemical compounds (such as lead poisoning), dental injuries (for instance from eating stones and ice), gastrointestinal bleeding, constipation, electrolyte disturbances, weight gain from high caloric intake (as with eating starch), nutritional deficiencies, intestinal obstruction, and parasitic infections.
Does pica cause problems for the baby?
A wide variety of problems can occur, depending on the nature of the substance that the mother ingests. In terms of outcomes for the baby, problems may include preterm birth, low birth weight, toxicity from lead, other heavy metals, herbicides, or insecticides, decreased head circumference (leading to various medical, emotional, and learning difficulties), and fetal or neonatal death.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the pica
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat pica during pregnancy?
Treatment varies widely, depending on the type of pica and the damage that it has caused. If iron deficiency, then the main treatment would be iron supplementation, beyond the doses of normal pregnancy vitamin/mineral supplements. If you suffer from lead poisoning, you may receive therapy with whats called a chelating agent, which grabs onto the unwanted substance for it to be removed. A chelating agent used widely for lead is EDTA, which may increase levels of lead in your brain, even though it removes lead from your body. Generally, the risks to the baby are less if you have the therapy than if you dont have it.
Who should NOT stop taking medication for pica during pregnancy?
Whether or not to stop a particular treatment always depends on the balance of risks versus benefits, and this assessment depends on the nature of the pica and the type and amount of damage that it is doing to you
What should I know about choosing a medication for my pica during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my pica when I am breastfeeding?
Iron supplements are safe in nursing mothers. Many questions remain unanswered regarding the safety of chelating agents, such as EDTA, in nursing mothers. However, if you suffer from high levels of lead or another toxic substance, this means that you should have a discussion with your physician and your pediatrician regarding whether you should avoid breastfeeding, in which case you could feed your baby with one of the excellent infant formulas on the market.
What alternative therapies besides medications can I use to treat my pica during pregnancy?
The effectiveness of various treatments depends on the nature of the pica. With various types of pica, certain types of psychotherapy, such as cognitive-behavioral therapy, could be useful. In the case of pregnancy, wherein t
he usual cause of pica is iron deficiency, treatments may consist of oral iron supplements, but if you are anemic and the condition is severe, your condition may require intravenous iron or even a blood transfusion.
What can I do for myself and my baby when I have pica during pregnancy?
Discuss your condition freely with your physicians. Often, people who suffer from pica resist talking about it with doctors and family, because they are concerned that it is part of a mental disorder. The underlying condition is a general medical problem, such as iron deficiency, especially during pregnancy. On the other hand, you should not be ashamed to discuss any concerns with a health care provider, including symptoms that may be part of a psychiatric condition.
Resources for pica in pregnancy:
For more information about pica during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: