Study focuses on pica prevalence and risks in many South Carolinians during pregnancy

Health promotion, education, and behavior assistant professor Leila Larson conducts her nutrition-focused maternal and child health research all over the world, and South Carolinians will soon benefit from her expertise. With funding from the USC Collaborative for Health Equity Research (CHEER), an equity-driven pilot project program recently established by the USC Office of the Provost, Larson has launched a new study focused on pica (i.e., the craving and consumption of non-food items, like ice, and sometimes earth, like clay or soil).

"Pica impacts pregnant women across the globe, including women in the U.S. – particularly those in African American, Hispanic and rural populations," says Larson. "Complications of prenatal pica include anemia, abnormal gestational weight gain, high blood pressure, negative birth outcomes, and other adverse effects, but despite these serious consequences, pica continues to be undiagnosed and underreported." 

Though understudied and extremely complex, scientists and clinicians suspect that one of the primary causes of pica is the deficiency of certain micronutrients, such as iron. Ironically, individuals with pica experience an urge to consume non-food items (e.g., soil, clay, baking powder, soap, cornstarch, chalk, paper products), which often fail to fill the nutrient gaps while also worsening the deficiencies by reducing absorption of nutrients and exacerbating unwanted health outcomes by potentially introducing toxins, heavy metals, parasites, and other dangerous substances to both mother and fetus.

In many parts of the world, pica is common and expected as it has long been seen as a normal part of pregnancy. In other areas, however, women hesitate to report their pica cravings and behaviors due to feelings of shame and fear of being stigmatized.

Only two studies have examined pica in populations in the U.S. in the last 25 years. In California, researchers found that 51% of Hispanic women had the condition. North Carolina scientists discovered that 38% of rural women had pica during pregnancy, yet 75% of the participants had no documentation of the condition in their medical records.

"Pica is viewed as a cultural practice, as well as a biological response to nutritional deficiencies, infection or stress," Larson says. "But with so little research on the topic, we just don't know enough about its prevalence, causes or impacts on pregnant women and their babies."

Building on her pica research in Malawi, which showed a reduction in consumption of earth when iron supplementation was provided, Larson's new study will shed light on which South Carolinians are most impacted by pica, what primarily causes pica in these populations, and how pregnant people experience pica in their everyday lives. By understanding their behaviors, perspectives, and experiences, the research team's long-term goal is to develop culturally relevant screening and treatment protocols that can be used by health care providers in the Palmetto state and beyond. 

Larson's study brings together a team of clinical, community, and research experts to explore this ubiquitous yet poorly understood condition. Consistent engagement with the study's Community Advisory Board will provide a much-needed perspective on the project's research approaches, study materials, dissemination, and much more.

"The cultural roots and high prevalence of prenatal anemia in the Southern United States makes pica a critical public health issue for this region," Larson says. "With this initial pilot project, we hope to lay the groundwork for a longer, more extensive study aimed at understanding the risk factors, behaviors, and clinical impacts associated with this condition, and how we might improve it using community-engaged research approaches."