DIETARY PATTERN AND PREVALENCE OF PICA AMONG PREGNANT WOMEN IN ENUGU EAST L.G.A ENUGU STATE

Maternal nutrition in pregnancy is an important reproductive health issue. It affects the growing baby indirectly through materno-fetal transfer, and directly post-partum, through lactation (Donahue et al ., 2009). Calories, proteins, vitamins and other important food elements needed by the developing foetus and the growing child are thus provided by the mother (Donahue et al ., 2009). Maternal nutrition is a modifiable factor by which pregnancy and birth outcome indices can be improved (Abu-Saad and Fraser, 2010). Adequate intake of certain food elements during pregnancy improves birth weight and labour spontaneity (Bawadi et al ., 2010; Fall et al ., 2009). Pregnancy is a critical stage of development during which maternal nutrition can strongly influence obstetric and neonatal outcomes (Kramer and Kakuma, 2003). During this period, optimal maternal nutrition is necessary to maintain the health of the pregnant woman, for proper fetal development, prevention of pregnancy complications and the occurrence of diseases in adulthood (Bojar et al ., 2006). An appropriate diet helps recovery from childbirth and favours breastfeeding (Arkkola et al., 2008). Maternal vitamin B12 during pregnancy has been said to be associated with the cognitive functions of offspring at 9 years of age. Also, placental and cord blood vitamin A has been positively associated with neonatal birth outcomes and children's neurodevelopment in later childhood (Zhang et al ., 2009; Chlotz and Phillips, 2009). Furthermore, children who experienced iodine deficiency during foetal developmental stage and early childhood tend to suffer cognitive impairment (Melse-Boonstra and Jaiswal, 2010). Therefore, some of the deficiencies that occur during pregnancy which mostly affect the unborn child might be associated with poor dietary practices exhibited by women during pregnancy, which are usually influenced by different factors such as nausea and vomiting which predisposes pregnant women to the consumption of none food substances (pica). 

Some pregnant women develop strong cravings for nonfood substances of little or no nutritional value such as dirt, soap, cigarette ashes, cigarette butts, chalk, ice, freezer frost, hair, starch, paint chips, burnt match heads, plaster, wax (Ellis and Schnoes, 2002; Callahan et al ., 2000; Lopez, 2004) clay, baking soda, tooth paste, coffee grounds, paper, sand or gravel, rust, charcoal, antacids, mothballs and broken crockery (Ellis and Schnoes, 2002). This common phenomenon is called pica. 

The term pica is derived from the Latin word magpie; a bird known to eat nearly anything (Rose, 2000). Although, consumption of some items may be harmless, pica is considered to be a serious eating disorder, sometimes resulting in serious health problems such as lead poisoning, bowel obstruction, intestinal pain, parasitic infections, dental injury, iron deficiency anemia, or in rare cases even death (Ellis and Schnoes, 2002; Rose, 2000). The drawbacks associated with this condition depend largely on what and how much is consumed. Consumption of non-nutritious foods can interfere with healthy eating habits resulting in deficiencies in vitamin and mineral levels in the pregnant woman (Ellis and Schnoes, 2002). Clay eating can cause ingestion of high levels of lead; it can bind potassium in the intestine, leading to severe hypokalemic myopathy. Clinicians caring for pregnant women with fatigue, muscle weakness, and hypokalemia should consider geophagia a type of pica as a possible cause (Ukaonu et al ., 2003). The ingestion of unusual substances also has resulted in other potentially life-threatening toxicities, such as hyperkalemia following cautopyreiophagia (the ingestion of burnt match heads) (Ellis and Schnoes, 2002). Iron deficiency anemia and less often potassium and zinc deficiency are the main complications of an excessive starch or clay ingestion, followed by gastrointestinal obstructions due to gastroliths or impaction. Additionally, naphthalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in matches pica), mercury poisoning (in paper pica) and lead poisoning (in dried paint pica) have been described. The exposure to infectious agents via contaminated ingested substances is another potential health hazard associated with pica, the nature of which varies with the content of the ingested material (Ellis and Schnoes, 2002). In particular, geophagia has been associated with soil-born parasitic infections, such as toxoplasmosis and toxocariasis. Gastrointestinal (GI) complications, including mechanical bowel problems, constipation, ulcerations, perforations and intestinal obstructions have resulted from pica (Ellis and Schnoes, 2002). Ingestion of paint chips can bring about lead poisoning. Ice consumption obviously is not poisonous to the system; however there is evidence of low levels of iron in the blood in the second and third trimesters when a pregnant woman consumes 1/2-2 cups of ice daily or a few times per week (Morales and Hayes-Bautista, 2000). Based on these findings, OTIENO (2010) reported that experts had earlier pointed out that these cravings have been in part due to long running traditions that women have followed which they should be educated on its dangers. Also, Ngozi (2008) concluded that it would better for pregnant women to eat balanced diet than remaining hooked to the myth that their changing bodies need non-food materials.

Despite the wide spread message which encouraged pregnant women to consume healthy foods for their sake and that of the growing fetus, most of them still crave for nonfood materials such as dirt, soap, cigarette ashes, chalk, ice, freezer frost, hair, starch, paint chips, burnt match heads, plaster, wax (Ellis and Schnoes, 2002; Callahan et al ., 2000), inform of pica, which is considered to be a serious eating disorder, sometimes resulting in serious health problems such as lead poisoning, bowel obstruction, intestinal pain, parasitic infections, dental injury, iron deficiency anemia or in rare cases even death (Callahan et al ., 2000).  Consumption of non-nutritious foods among pregnant women could interfere with healthy eating habits resulting in deficiencies in vitamin and mineral levels in the pregnant woman (Morales and Hayes-Bautista, 2000). It could expose them to infectious agents through consumption of contaminated substances (Lopez, 2004). Consumption of none food substances (pica) could lead to mechanical bowel problems, constipation, ulcerations, perforations and intestinal obstructions (Ellis and Schnoes, 2002). Ingestion of paint chips can bring about lead poisoning. Ice consumption could lead to low levels of iron in the blood in the second and third trimesters when a pregnant woman consumes it daily or a few times per week. Elevated magnesium blood concentrations caused by pica consumption could depress maternal respiratory and cardiac rates or depressed fetal heart rate activity. Furthermore, pica is a worldwide problem that has no barriers of age, race, sex or geographic region (Morales and Hayes-Bautista, 2000), which shows the need for dietary pattern among pregnant women as to prevent the deficiency of vitamins and minerals caused by pica.

The general objective of the study was to assess dietary pattern and prevalence of pica among pregnant women in Enugu East Local government.

i. assess the socio-economic characteristics of the study women. 

ii. evaluate the dietary pattern of the study women using food frequency questionnaire.

iii ascertain the knowledge of the respondents on pica consumption.

iv assess the pica consumption pattern of the study women.

vi. determine types of pica practices among the study women.

vii determine the perception of the women that practice pica consumption

iv. determine the relationship between dietary pattern and pica consumption of the women.

Information gotten from this study would be used in improving strategies for dealing with pica practice among pregnant women in a healthy way. It would enable nurses   to raise questions about the presence of pica practice among pregnant women as to discourage its  consumption among pregnant women during antenatal care clinics. Health officers and Human Nutrition Department all over the world would utilize information from this study to know prevalence of pica among pregnant women in Enugu East and this would serve  as a basis for their campaign against the intake of none food substances among pregnant women.  It would serve as base for educational researchers to carry out more research on this topic, especially in Nigeria, owing to the scarce information on it. It would be of importance to intending mothers on the need to abstain from pica based on its health implications.