Pica in Pregnant Women With Diabetes
Pica in Pregnant Women With Diabetes
Our results clearly showed that the phenomenon of pica does exist amongst pregnant women with diabetes. The magnitude of this phenomenon in the wider antenatal population in the UK however remains unknown, but our results suggest that it may not be as rare in Western population as previously suggested. There is a wide variation in the prevalence of pica in different populations globally with reported rates of as low as 0.02% and as high as 84%; with higher rates in Africa, Asia, Latin America and rural south western America.
Putative theories underlying pica include micronutrient deficiencies, gastrointestinal distress, hunger, increased susceptibility to pathogens and cultural disposition.
Geophagy has been linked with anaemia, abdominal pain and higher than normal serum levels of arsenic, cadmium and lead whilst cases of severe anaemia have been described in association with amylophagia and pagophagia. Rarer complications described in association with pica include mercury poisoning (paper pica), lead poisoning (dried paint). Even though we did not find any case of severe anaemia in any of the 13 women who reported a history of pregnancy related pica based on haemoglobin levels at 28 weeks gestation (Figure 1); a much more focused study on the aetiology of severe anaemia in pregnancy in the UK would be desirable to demonstrate any pica-related impact previously described in the literature.
The impact of pica on pregnancy and pregnancy outcome in women with diabetes has not been fully studied. However, amylophagia probably poses the greatest potential risk in relation to glycaemic control, depending on the type of uncooked starch that is consumed. A case of amylophagia presenting as gestational diabetes has been described. In the reported case, the gestational hyperglycaemia spontaneously resolved following cessation of amylophagia. This strongly underlines the importance of eliciting a possible history of pica in all patients attending the antenatal diabetes clinics, especially in patients with gestational diabetes.
The existence of pica can be easily discovered simply by asking pregnant women. This requires a level of awareness on the part of health workers delivering antenatal care including midwives and obstetricians. By making an 'early diagnosis' of pica in the antenatal period, appropriate strategies can be put in place regarding further evaluation and nutritional education and support. It would be clinically prudent to exclude pica in all cases of severe iron deficiency anaemia diagnosed in pregnancy.
In conclusion, the practice of pica amongst pregnant women with diabetes is a reality and further work is needed to define the scale of the phenomenon and its impact on pregnancy outcomes in the UK. In addition, the aetiology of pica needs further clarification through focused research efforts into this enigmatic phenomenon. Health professionals looking after pregnant women should be alerted to the existence of pica. The authors recommend that questioning about the practice of pica should be part of the antenatal booking history.
Discussion
Our results clearly showed that the phenomenon of pica does exist amongst pregnant women with diabetes. The magnitude of this phenomenon in the wider antenatal population in the UK however remains unknown, but our results suggest that it may not be as rare in Western population as previously suggested. There is a wide variation in the prevalence of pica in different populations globally with reported rates of as low as 0.02% and as high as 84%; with higher rates in Africa, Asia, Latin America and rural south western America.
Putative theories underlying pica include micronutrient deficiencies, gastrointestinal distress, hunger, increased susceptibility to pathogens and cultural disposition.
Geophagy has been linked with anaemia, abdominal pain and higher than normal serum levels of arsenic, cadmium and lead whilst cases of severe anaemia have been described in association with amylophagia and pagophagia. Rarer complications described in association with pica include mercury poisoning (paper pica), lead poisoning (dried paint). Even though we did not find any case of severe anaemia in any of the 13 women who reported a history of pregnancy related pica based on haemoglobin levels at 28 weeks gestation (Figure 1); a much more focused study on the aetiology of severe anaemia in pregnancy in the UK would be desirable to demonstrate any pica-related impact previously described in the literature.
The impact of pica on pregnancy and pregnancy outcome in women with diabetes has not been fully studied. However, amylophagia probably poses the greatest potential risk in relation to glycaemic control, depending on the type of uncooked starch that is consumed. A case of amylophagia presenting as gestational diabetes has been described. In the reported case, the gestational hyperglycaemia spontaneously resolved following cessation of amylophagia. This strongly underlines the importance of eliciting a possible history of pica in all patients attending the antenatal diabetes clinics, especially in patients with gestational diabetes.
The existence of pica can be easily discovered simply by asking pregnant women. This requires a level of awareness on the part of health workers delivering antenatal care including midwives and obstetricians. By making an 'early diagnosis' of pica in the antenatal period, appropriate strategies can be put in place regarding further evaluation and nutritional education and support. It would be clinically prudent to exclude pica in all cases of severe iron deficiency anaemia diagnosed in pregnancy.
In conclusion, the practice of pica amongst pregnant women with diabetes is a reality and further work is needed to define the scale of the phenomenon and its impact on pregnancy outcomes in the UK. In addition, the aetiology of pica needs further clarification through focused research efforts into this enigmatic phenomenon. Health professionals looking after pregnant women should be alerted to the existence of pica. The authors recommend that questioning about the practice of pica should be part of the antenatal booking history.
Source...