Pica During Pregnancy: Causes and Treatments

By OBGYN Dr. Kenosha Gleaton

What is Pica?

Pica is an eating disorder characterized by the repeated consumption of non-food items. More specifically, pica is defined as the intake of substances for at least a month that have no nutritional value and are not part of a culturally or socially supported practice. [1] Essentially, people with pica have the urge to eat items such as paper, clay, dirt, and so on. 

How Common is Pica?

It’s difficult for researchers to determine how common pica actually is, as many people may not self-report due to embarrassment, shame, or mental health struggles. [1] In general, it is thought that pica is more common in children, people with obsessive-compulsive disorder (OCD), and pregnant people. [1-3] One study suggests that pica is severely underestimated and may be as high as 65%, however, a meta-analysis from 2016 reviewed 70 studies and concluded that a rough estimate may be closer to 27.8%. [4-5] The meta-analysis also found that the prevalence of pica is the highest in Africa and that factors such as education and anemia may play a role in prevalence. [5] 

What are the Different Types of Pica?

You may be wondering what kind of “non-food items” people with pica consume. There are more common types of pica, such as the consumption of earth (dirt and rocks), raw starches (corn-starch or uncooked rice), and large quantities of ice. [1] These are not the only types of substances people may consume. Other examples include paper, bits of plastic, cardboard, and more. [1] 

The Health Concerns of Pica

Pica can be a dangerous condition, especially during pregnancy. Consuming non-food items may lead to worsened nutritional deficiencies, blockages in the digestive tract, weight loss, poisoning, parasites, and more. [1] Pica is especially concerning if someone is ingesting dirt, plastic, or other toxic items. If all you seem to be craving is ice, you are less likely to cause any harm to yourself or your pregnancy. However, you should still speak to a healthcare provider about your pregnancy cravings and aversions, especially if you’re craving non-food items. Pica may not be widely discussed, but it is estimated to occur in about a quarter of pregnancies. [5] 

What Causes Pica During Pregnancy?

So why does pica happen? Truthfully there is not one specific cause that we can pinpoint, but there have been some observed factors that may play a role in the onset of pica.

Nutritional Deficiencies 

A few studies suggest that vitamin and mineral deficiencies could cause pica. [1] Most observed deficiencies include iron and zinc. Iron deficiency may lead to anemia, which is one of the most well documented causes of pica during pregnancy. [1,5] There are many nutritional needs during pregnancy, and iron is especially important for maintaining increased blood volume. [6] Nausea and vomiting during pregnancy can also exacerbate nutritional deficiencies, as it may be harder to consume or digest nutritious foods. 

Symptoms of Nutritional Deficiencies

While pica is not always associated with a vitamin or mineral deficiency, there have been some documented connections. [1] It’s important to know the signs of a nutritional deficiency so that you can speak with a healthcare provider and correct the deficiency quickly. Symptoms can vary widely, but some common signs include [7]:

• Fatigue
• Weakness
• Headaches
• Cold hands and feet
• Chest pain
• Dizziness
• Irregular heartbeat
• Changes in skin color
• Shortness of breath

Mental Health Conditions

There have been multiple studies focused on the correlations between pregnancy, OCD, and pica. We know that the onset of OCD or pica is slightly increased during pregnancy, and pica may actually be a symptom of OCD. [2] Studies have also highlighted associations between pica and high levels of stress. [8] 

Symptoms of OCD 

OCD is not always related to pica, but some studies have found an association. If you notice other symptoms of OCD or other mental health conditions, you should seek out a healthcare professional. Some common symptoms of OCD include [9]:

• Unwanted thoughts 
• Fear of contamination or dirt
• Intense stress when objects aren’t orderly or symmetrical
• Aggressive or horrific thoughts about harming oneself or others
• Compulsive actions such as washing, cleaning, and counting. 

How to Treat Pica During Pregnancy

At this time, little is known about treatments for pica. [3] Typically treatment will be focused on whatever caused or triggered the onset of pica. Behavioral modifications, treating nutritional deficiencies, treating morning sickness, and managing underlying mental conditions may be useful. [3,8] Your healthcare provider should be able to test your blood to measure your mineral levels and may screen you for other symptoms of OCD. There are also ways to manage nausea and vomiting during pregnancy through diet, lifestyle changes, supplements, and medications. [10] If someone is experiencing the urge to eat a specific item, reducing access or providing healthy substitutes with similar textures may be useful. [8] 

Preventing Pica

There isn’t a specific method for preventing pica, as we still aren’t sure exactly what causes it. [8] There’s no guarantee that any methods can actually stop pica from developing, but there are ways to support your pregnancy and food cravings, aversions, or morning sickness. Taking a comprehensive prenatal vitamin is a great way to support your nutritional needs during pregnancy. [6] If you notice signs of anemia or any vitamin deficiencies, you should speak to a healthcare provider about getting your levels tested. If you do have any deficiencies, your provider can help you with a diet or supplement plan. You should also speak to a healthcare provider if you notice any signs of OCD or other mental health conditions. 

If you are experiencing morning sickness, food cravings, or food aversions, you may be able to find relief through diet and lifestyle changes. Research shows that vitamin B6 and ginger may be helpful for reducing feelings of nausea during pregnancy. [10] 

Key Takeaways

• Pica is an eating disorder defined by the regular consumption of non-food items. 
• It’s unknown exactly how common pica is, but research suggests that pica may occur in about a quarter of pregnancies.
• Those with pica may have the urge to consume clay, dirt, raw starch, large quantities of ice, and other substances.
• Researchers aren’t exactly sure what causes pica, but data suggests that nutritional deficiencies, region, and mental health may play a role. 
• There aren’t specific treatments or preventions for pica, but it is recommended that pregnant people prioritize their nutrition and mental health concerns, manage morning sickness, and avoid or remove triggering objects and substances. 

References:

1. Konlan KD, Abdulai JA, Konlan KD, Amoah RM, Doat AR. Practices of pica among pregnant women in a tertiary healthcare facility in Ghana. Nurs Open. 2020;7(3):783-792. Published 2020 Jan 28. doi:10.1002/nop2.451
2. Upadhyaya SK, Sharma A. Onset of obsessive compulsive disorder in pregnancy with pica as the sole manifestation. Indian J Psychol Med. 2012;34(3):276-278. doi:10.4103/0253-7176.106030
3. Attia, E. Walsh, T. Pica. Merck Manual Consumer Version. September 2022. URL. 
4. López LB, Ortega Soler CR, de Portela ML. La pica durante el embarazo: un trastorno frecuentemente subestimado [Pica during pregnancy: a frequently underestimated problem]. Arch Latinoam Nutr. 2004;54(1):17-24.
5. Fawcett EJ, Fawcett JM, Mazmanian D. A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. Int J Gynaecol Obstet. 2016;133(3):277-283. doi:10.1016/j.ijgo.2015.10.012
6. Nutrition During Pregnancy. FAQ001. American College of Obstetricians and Gynecologists. May 2023. URL.
7. Anemia. Mayo Clinic. May 11 2023. URL. 
8. Al Nasser Y, Muco E, Alsaad AJ. Pica. [Updated 2022 Nov 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532242/
9. Obsessive-compulsive disorder (OCD). Mayo Clinic. March 11 2020. URL. 
10. Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Womens Health. 2010;2:241-248. Published 2010 Aug 4. doi:10.2147/ijwh.s6794