We sought to describe the impact of pica, the craving for and intentional ingestion of substances not defined as food, as a risk factor for lead poisoning in New York City (NYC) pregnant women. In order to describe pregnant women with elevated blood lead levels (BLLs) who report pica, NYC health department data from 491 cases of lead-poisoned pregnant women from January 2001 to June 2009 were reviewed. Descriptive frequencies were obtained for women reporting pica. Data were compared between women reporting and not reporting pica. In NYC, of the 43 (9%) lead-poisoned pregnant women reporting pica, 42 (97.7%) were immigrants and 28 (64.6%) had consumed soil. Compared to lead-poisoned pregnant women not reporting pica, women reporting pica had higher peak BLLs (29.5 vs. 23.8 μg/dL, P = 0.0001), were more likely to have had a BLL ≥ 45 μg/dL (OR = 3.3, 95% CI, 1.25, 8.68) and receive chelation (OR = 10.88, 95% CI, 1.49, 79.25), more likely to have emigrated from Mexico (OR = 3.05, 95% CI, 1.38–6.72), and less likely to have completed high school (OR = indeterminate; 0 vs. 34%; P = 0.003). Among NYC lead-poisoned pregnant women, pica was associated with higher peak BLLs. Providers in NYC, and possibly other urban settings, should be vigilant and question pregnant women, especially immigrants, about pica and strongly consider testing this at-risk population for lead poisoning.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
(2010). Guidelines for the identification and management of lead exposure in pregnant and lactating women. Atlanta: Centers for Disease Control and Prevention.
Irgens, Å., Krüger, K., Skorve, A. H., et al. (1998). Reproductive outcome in offspring of parents occupationally exposed to lead in Norway. American Journal of Industrial Medicine, 34(5), 431–437.
Magri, J., Sammut, M., & Savona-Ventura, C. (2003). Lead and other metals in gestational hypertension. International Journal of Gynecology & Obstetrics, 83(1), 29–36.
Borja-Aburto, V. H., Hertz-Picciotto, I., Lopez, M. R., et al. (1999). Blood lead levels measured prospectively and risk of spontaneous abortion. American Journal of Epidemiology, 150(6), 590–597.
Torres-Sánchez, L. E., Berkowitz, G., López-Carrillo, L., et al. (1999). Intrauterine lead exposure and preterm birth. Environmental Research, 81(4), 297–301.
Tang, H.-W., Huel, G., Campagna, D., et al. (1999). Neurodevelopmental evaluation of 9-month-old infants exposed to low levels of lead in utero: Involvement of monoamine neurotransmitters. Journal of Applied Toxicology, 19(3), 167–172.
Emory, E., Ansari, Z., Pattillo, R., et al. (2003). Maternal blood lead effects on infant intelligence at age 7 months. American Journal of Obstetrics and Gynecology, 188(4), S26–S32.
Jedrychowski, W., Perera, F. P., Jankowski, J., et al. (2009). Very low prenatal exposure to lead and mental development of children in infancy and early childhood: Krakow prospective cohort study. Neuroepidemiology, 32(4), 270–278.
Young, S. L. (2010). Pica in pregnancy: New ideas about an old condition. Annual Review of Nutrition, 30(1), 403–422. doi:10.1146/annurev.nutr.012809.104713.
Horner, R. D., Lackey, C. J., Kolasa, K., et al. (1991). Pica practices of pregnant women. Journal of the American Dietetic Association, 91(1), 34–38.
Erdem, G., Hernandez, X., Kyono, M., et al. (2004). In-utero lead exposure after maternal ingestion of Mexican pottery: Inadequacy of the lead exposure questionnaire. Clinical Pediatrics, 43, 185–187. doi:10.1177/000992280404300209.
Shannon, M. (2003). Severe lead poisoning in pregnancy. Ambulatory Pediatrics, 3(1), 37–39.
Klitzman, S., Sharma, A., Nicaj, L., et al. (2002). Lead poisoning among pregnant women in New York City: Risk factors and screening practices. Journal of Urban Health, 79(2), 225–237.
Smulian, J. C., Motiwala, S., & Sigman, R. K. (1995). Pica in a rural obstetric population. Southern Medical Journal, 88(12), 1236–1240.
Bruhn, C. M., & Pangborn, R. M. (1971). Reported incidence of pica among migrant families. Journal of the American Dietetic Association, 58(5), 417–420.
Rothenberg, S. J., Manalo, M., Jiang, J., et al. (1999). Maternal blood lead level during pregnancy in South Central Los Angeles. Archives of Environmental Health, 54(3), 151–157.
Simpson, E., Mull, J. D., Longley, E., et al. (2000). Pica during pregnancy in low-income women born in Mexico. Western Journal of Medicine, 173(1), 20–24. discussion 5.
Katz, J. M. (2008). Poor haitians resort to eating dirt. In: National geographic news. http://news.nationalgeographic.com/news/2008/01/080130-AP-haiti-eatin.html. Accessed November 3, 2009.
Hamilton, S., Rothenberg, S. J., Khan, F. A., et al. (2001). Neonatal lead poisoning from maternal pica behavior during pregnancy. Journal of the National Medical Association, 93(9), 317–319.
Federman, D. G., Kirsner, R. S., & Federman, G. S. (1997). Pica: Are you hungry for the facts? Connecticut Medicine, 61(4), 207–209.
Bhatia, M. S., & Gupta, R. (2009). Pica responding to SSRI: An OCD spectrum disorder? World Journal of Biological Psychiatry, 10(4 Pt 3), 936–938. doi:10.1080/15622970701308389.
Cooksey, N. R. (1995). Pica and olfactory craving of pregnancy: How deep are the secrets? Birth, 22(3), 129–137.
Abrahams, P., & Parsons, J. (1996). Geophagy in the tropics: A literature review. Geographical Journal, 162, 63–72.
Hunter, J., & DeKleine, R. (1984). Geophagy in Central America. Geographical Review, 74, 157–169.
Boyle, J. S., & Mackey, M. C. (1999). Pica: Sorting it out. Journal of Transcultural Nursing, 10(1), 65–68. doi:10.1177/104365969901000116.
Kettaneh, A., Eclache, V., Fain, O., et al. (2005). Pica and food craving in patients with iron-deficiency anemia: A case-control study in France. The American Journal of Medicine, 118(2), 185–188.
López, L. B., Langini, S. H., & Pita de Portela, M. L. (2007). Maternal iron status and neonatal outcomes in women with pica during pregnancy. International Journal of Gynecology & Obstetrics, 98(2), 151–152.
Corbett, R. W., Ryan, C., & Weinrich, S. P. (2003). Pica in pregnancy: Does it affect pregnancy outcomes? American Journal of Maternal Child Nursing, 28(3), 183–189.
Rainville, A. J. (1998). Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery. Journal of the American Dietetic Association, 98(3), 293–296.
Lacey, E. P. (1990). Broadening the perspective of pica: Literature review. Public Health Reports, 105(1), 29–35.
Screening for Elevated Blood Lead Levels in Children and Pregnant Women, Topic Page. U.S. Preventive Services Task Force. December 2006. http://www.uspreventiveservicestaskforce.org/uspstf/uspslead.htm. Accessed December 27, 2011.
Live Births in New York City, 1998–2007. New York City Department of Health and Mental Hygiene, New York. 2009. http://www.nyc.gov/html/doh/downloads/pdf/ms/bimt-maternal-nativity.pdf. Accessed January 4, 2010.
Rivera-Batiz, F. (2003). The State of Newyork Atilitan: A socioeconomic profile of Mexican New Yorkers.
Edwards, C. H., Johnson, A. A., Knight, E. M., et al. (1994). Pica in an urban environment. Journal of Nutrition, 124(6_Suppl), 954S–962S.
Callahan, G. N. (2003). Eating dirt. Emerging Infectious Diseases, 9(8), 1016–1021.
Wiley, A. S., & Solomon, H. K. (1998). Geophagy in pregnancy: A test of a hypothesis. Current Anthropology, 39(4), 532–545.
Live Births by Maternal Education. (2009). New York City Department of Health and Mental Hygiene, New York. http://www.nyc.gov/html/doh/downloads/pdf/ms/bimt-maternal-education.pdf. Accessed November 3, 2009.
Epiquery: NYC Interactive Health Data System Mother’s First Prenatal Care—Vital Statistics Birth Data 2007 [database on the Internet]. New York City Department of Health and Mental Hygiene. 2010 [cited January 10 2010]. Available from: http://a816-healthpsi.nyc.gov/epiquery/SASStoredProcess/guest?_PROGRAM=/EpiQuery/Birth/birthgraph2&years=%23&topic=%23&qtype=strat&pop=kpnc&row=none&year=2007&topics=Live+Births.
Live Births to Women Receiving Late or No Prenatal Care by Maternal Race/Ethnicity and Age. New York City Department of Health and Mental Hygiene, New York. 2009. http://www.nyc.gov/html/doh/downloads/pdf/ms/bimt-late-or-noprenatal-care.pdf. Accessed November 3, 2009.
Summary of Vital Statistics 2001. (2002). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2002. (2003). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2003. (2004). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2004. (2005). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2005. (2006). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2006. (2007). The City of New York: New York City Department of Health and Mental Hygiene.
Summary of Vital Statistics 2007 The City of New York: New York City Department of Health and Mental Hygiene2008.
Bellinger, D. C. (2005). Teratogen update: Lead and pregnancy. Birth Defects Research, 73(6), 409–420.
Summary of Vital Statistics 2009. (2010). The City of New York: New York City Department of Health and Mental Hygiene.
Ehrlich, J., Nagin, D., Greene, D., Clark, N., Leighton, J. (2009). Lead poisoning: prevention, identification, and management. New York City Department of Health and Mental Hygiene May 2009 Contract No.: 28(suppl 3).
The authors would like to thank Slavenka Sedlar for her guidance in data collection, analysis, and interpretation.
Conflict of interest
About this article
Cite this article
Thihalolipavan, S., Candalla, B.M. & Ehrlich, J. Examining Pica in NYC Pregnant Women with Elevated Blood Lead Levels. Matern Child Health J 17, 49–55 (2013). https://doi.org/10.1007/s10995-012-0947-5
- Lead poisoning