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• PICA PREGNANCY MANUAL

There is a strong evidence of a relationship between pica and anaemia in pregnant women (Young et al., 2010).

Intake of pica among pregnant women is an issue of health concern that has brought about high medical conditions in pregnancy, especially iron deficiency and anaemia in pregnancy. Higher incidence is associated with pregnancy, developmental delay and mental retardation, psychiatric disease and autism, early childhood, poor nutrition or low blood levels of iron and other minerals and certain cultural or religious traditions (Rose, Porcerelli, & Neale, 2000). Although pica may be practised by both children and adults, it is not limited to, any culture, race, sex or socioeconomic status. It was four times higher in black than in white women. The outcome of the study was that race was a major risk factor for pica during pregnancy. The nature and characteristics of people who eat pica is documented, and this is evident in a meta‐analysis of dirt‐, clay‐ and starch‐eating women conducted by Horner et al. ( 2016) reported that certain heavy metals in pica substances, zinc, manganese and cobalt, can interfere with the iron intestinal absorption pathway. For example, most pregnant women eat clay (“ayilor”) to satisfy their cravings and this can cause severe constipation and anaemia (Horner, Lacey, Kolasa, & Warren, 1991). Myths and misunderstanding surrounding eating of non‐food items can expose pregnant women to serious health consequences. ( 2014) reported that mothers could suffer from dental injuries, intestinal obstructions, toxaemia, constipation, lead poisoning, parasitic infections and hyperkalaemia if the intake of pica becomes pervasive. Maternal under nutrition results in increased risks of short‐term consequences such as intrauterine growth restriction (IUGR), low birth weight, preterm birth, prenatal and infant mortality and morbidity (Fekadu Beyene, 2013). The yearning and conscious consumption of non‐food stuff is common among many populations, especially during pregnancy, yet the health consequences are not well understood (Lin et al., 2015). Its true prevalence is difficult to assess because most people do not report pica (Mishori & McHale, 2014) or may not even identify its detrimental health effect. Countless expositions describe other forms of pica, including eating ice, dirt, soil and clay, starch, burnt matches, cardboard, hair, laundry detergent, chalk, soap, firecrackers and metal artefacts such as coins. An extraordinary array of inedible materials consumed by psychotic patients indicates this behaviour might be a cardinal sign of psychosis, "a perversion of the appetite" (Blinder & Salama, 2008). Others have studied pica's positive health effects, such as providing micronutrients (Geissler et al., 1999), soothing gastrointestinal upset or preventing harmful chemicals or pathogens from entering the bloodstream (Young et al., 2010). Investigators from diverse fields have explored pica's causal role in conditions such as heavy metal poisoning, especially lead (Geissler et al., 1999), micronutrient imbalances (by binding with consumed food or preventing absorption in the small intestine) and transmission of parasites (Young et al., 2010). The most common types of pica are geophagy (consumption of earth), amylophagy (consumption of raw starches such as corn‐starch or uncooked rice) and pagophagy (the consumption of large quantities of ice) (Young et al., 2010). The term pica originates from a Latin word “magpie,” a bird that is famed for its unusual eating behaviours, where it is known to eat almost everything (Kaur, 2014). Four diagnostic criteria for pica are generally noted as follows: the persistent eating of non‐nutritive substances for the period of at least 1 month the eating behaviour, not part of a culturally sanctioned practice the eating of non‐nutritive substances which is inappropriate to the developmental level if the eating behaviour occurs exclusively during the course of another mental disorder, which is sufficient to warrant independent clinical attention (Hartmann, Becker, Hampton, & Bryant‐Waugh, 2012).

PICA PREGNANCY MANUAL

The Diagnostic and Statistical Manual of Mental Disorders (2013) described pica as persistent intake of non‐nutritive substances for at least 1 month that is inappropriate to developmental level and not part of a culturally supported or socially normative practice (Mishori & McHale, 2014). Generally, pica is defined as the repeated ingestion of non‐food items which is normally insatiable and leads to compulsive consumption (Ellis, Figueredo, Brumbach, & Schlomer, 2009). Adequate intake of nutrition is a key component for an individual's health and well‐being, particularly during pregnancy (Fekadu Beyene, 2013).