Dear Dr Mitchell,

I am 20 weeks pregnant and take my prenatal vitamins everyday. I also try to maintain a balanced diet, and still do my exercises. My problem is that I constantly crave ice and dirt, and often find myself sneaking away to eat them. I know this — especially the dirt — can be harmful, but I just can’t help myself. How can I be lacking nutrients when I am doing all I can to ensure that I don’t lack anything?

The uncontrollable desire or practice of eating ice and dirt is called pica. This is not normal and is usually an indication of an underlying deficiency in your nutritional status. The unusual craving or habit of eating things that are not food is more common in pregnant women. Those most at risk of pica are those who have poor nutrition or deficiencies in their nutrients such as iron, and also those pregnant mothers who have a history of cultural exposure to eating these non-food items.

Some of the non-food items that women may eat when they have pica include clay, dirt, soap, baby powder, ash, cornstarch, uncooked rice or grains, hair, paint chips, glue, metal and small stones.

When you do not get an adequate intake of nutrients, then your body might crave these non-food items. During pregnancy the increased demands of pregnancy for nutrients may lead to deficiency in certain nutrients, especially iron and zinc. Nausea and vomiting in the first 14 weeks of pregnancy may also lead to a deficiency in your nutrition. This significantly limits your intake, and hence your intake of iron, zinc and B vitamins is significantly reduced and this can cause the increased craving for the ice and dirt.

Pica is not always harmful but it is important to determine the underlying cause to decrease the associated risks. The craving of ice is not harmful, but anaemia in pregnancy can be harmful to both you and your baby. Eating non-food items such as dirt can make you ill. This can also make you feel full, leading you not eating enough nutritious food to support the growth of your baby.

Pica can also lead to complications such as stomach irritation, infections such as worm infestation, blockage in your intestines, vomiting and significant weight loss. You might also eat toxins in the dirt or other non-food items.

Taking your prenatal vitamins and using treatment for nausea and vomiting can help to increase your intake of nutritional foods. The use of nutritional food replacement drinks will also help to replace the vitamins, iron and zinc that you need to support the needs of the growing foetus until your appetite returns.

In most cases the increased craving for these non-food items such as dirt goes away on its own after the first trimester of pregnancy. You should aim to eat three meals a day plus a snack or two. Some women may choose to eat smaller, more frequent meals.

Consult your doctor who will investigate you for any underlying deficiency in your nutrition such as low blood count due to low iron and vitamin B intake. This is important to ensure a good outcome for yourself and the baby.

Congratulations on your pregnancy and I wish for you a safe delivery and a healthy baby.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.