Preventing Pica Starts Before Your Pregnancy

Unusual food cravings and food aversions are a normal part of pregnancy. But if the cravings are for inedible items such as dirt, chalk, and laundry starch or for edible but non-nutritious things such as ice and corn starch, you have what is called "pica of pregnancy". Pica is not a disease or a condition, it is an eating disorder that has been discussed and treated since the very early days of medicine. Paul of Aegina, a 7th-century Greek physician, explained it like this: Their appetite is capricious and they display a craving for the things generally regarded as very bad.

What causes pica? "The cause of pica is obscure." That's medical talk for "we have no clue why adult humans start eating inedible things." Except for the pica seen in some mentally abnormal persons, pica is usually a symptom of a nutritional problem. The first person I met with pica was a man, and he wasn't pregnant. He was crunching his 4th glass of ice that December morning when the pathologist and I came to take a bone marrow sample from him to see why he was anemic. (He had a rare, fixable condition that locked up his iron supplies and prevented his body from using them to make hemoglobin.)

The association between pica, pregnancy and anemia is so strong and so well known that questions about eating starch, ice and other non-food items were part of the standard screening interview in our pregnancy clinics. We would treat the anemia and the pica almost always vanished. The top two causes of anemia in women are iron deficiency and folate deficiency. Steady iron losses from menstrual periods and the fad diets of adolescence leave a woman ill-prepared for the demands of pregnancy. The result is often anemia and the resulting pica.

Can pica be harmful? Letting the underlying anemia go untreated can be dangerous, leading to a anemic baby, and an exhausted and anemic new mother. The pica can also cause you to eat harmful things. Eating dirt exposes you to various parasites and pathogens and even lead and mercury, depending on where the dirt comes from. Eating starch is consuming empty calories, which makes the malnutrition worse, which leads to more pica. Eating paint chips can lead to lead poisoning (this is more a problem with toddlers in old housing than pregnant women). Even the relatively benign ice-munching can chip your teeth.

Can pre-pregnancy planning and preparation prevent pica problems? Yes, but can you say that sentence quickly three times? The best time to start your pregnancy nutrition program is before you get pregnant, because a low folic acid level in the first few weeks of pregnancy can cause severe birth defects (neural tube defects, including spina bifida). Ask your doctor to check you for anemia before you get pregnant, improve your diet, and start taking the recommended supplements. Then get pregnant. This is not a 100% guarantee you will not develop pica, but it minimizes the possibility.

During pregnancy, if you suddenly realize you are standing in the kitchen, spooning corn starch into your mouth straight from the box ... don't panic. You are not going crazy. Don't hide the cravings, deal with them. Here's some suggestions for you:

* Review what you have been eating? Are you getting plenty of leafy green vegetables and iron-rich foods?

* Call your obstetrician's staff and let them know what's going on. They will check for anemia and may suggest some supplements.

* Call a friend and ask them to be your anti-pica buddy. Call your friend when you start looking at the bag of potting soil as a tasty snack and let them talk you out of the idea.

* Try a substitute, such as celery, carrots, apples or other crunchy and low-calorie foods. The most common pica targets reported - ice, corn starch, laundry starch, and dirt - are crunchy.

REFERENCES:

http://www.americanpregnancy.org/pregnancyhealth/unusualcravingspica.html

http://www.pregnancy-info.net/pica.html

Enumeration of the "Cravings" of Some Pregnant Women, J. M. Harries and T. F. Hughes, Br Med J. 1958 July 5; 2(5087): pp39-40

The Medical Works of Paulus Aegineta, the Greek Physician:, Francis Adams (translator), Welsh, Treuttel, Würtz, 1834