Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania

Abstract

The etiology of pica, the purposive consumption of non-food substances, is not understood, despite its ubiquity among gravidae. We examined correlates of pica in a representative obstetric population (n = 2,368) on Pemba Island, Zanzibar, Tanzania to examine proposed etiologies. Cross-sectional data were collected on socioeconomic characteristics, food intake, geophagy (earth consumption), amylophagy (raw starch consumption), anthropometry, iron status, parasitic burden, and gastrointestinal morbidities. Amylophagy was reported by 36.3%, geophagy by 5.2%, and any pica by 40.1%. There was a strong additive relationship of geophagy and amylophagy with lower hemoglobin (Hb) concentration and iron deficiency anemia. By multivariate logistic regression, any pica was associated with Hb level (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.72-0.81), nausea (OR = 1.45, 95% CI = 1.20-1.73), and abdominal pain (OR = 1.22, 95% CI = 1.01-1.48). These striking results indicate that the nature of the relationship between pica, pregnancy, gastrointestinal distress, and iron deficiency anemia merits further investigation.

Figure 1.

Pica behavior by pregnancy status, Zanzibar, Tanzania. Prevalence of geophagy and amylophagy was significantly higher (*) among pregnant women than among non-pregnant women (P < 0.001). Current pica behavior by gestational age at enrollment among 2,367 pregnant women.

Figure 2.

Predicted means of (A) hemoglobin and (B) zinc protoporphyrin (ZPP) and (C) proportion with iron deficiency anemia (IDA) for mean gestational age and having no hookworm or malaria infection by pica behavior at any point in pregnancy and at time of baseline interview, Zanzibar, Tanzania. *Significant (P < 0.05) in regression model. **Significant differences were calculated based on the logged values of ZPP, but unlogged values are reported for ease of interpretation. ***IDA defined as ZPP > 80 μmol/mol and hemoglobin < 11.0 g/dL.