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Mohan S, Mahonski S, Koziatek C, Cohen ET, Smith S, Su MK. Induction of Labor at Term for Severe Antenatal Lead Poisoning. J Med Toxicol 2023; 19:401-404. [PMID: 37365427 PMCID: PMC10522539 DOI: 10.1007/s13181-023-00955-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Antenatal lead exposure is associated with multiple adverse maternal and fetal consequences. Maternal blood lead concentrations as low as 10 µg/dL have been associated with gestational hypertension, spontaneous abortion, growth retardation, and impaired neurobehavioral development. Current treatment recommendations for pregnant women with a blood lead level (BLL) ≥ 45 µg/dL include chelation. We report a successful case of a mother with severe gestational lead poisoning treated with induction of labor in a term infant. CASE REPORT A 22-year-old G2P1001 female, at 38 weeks and 5 days gestation, was referred to the emergency department for an outpatient venous BLL of 53 µg/dL. The decision was made to limit ongoing prenatal lead exposure by emergent induction as opposed to chelation. Maternal BLL just prior to induction increased to 70 µg/dL. A 3510 g infant was delivered with APGAR scores of 9 and 9 at 1 and 5 min. Cord BLL at delivery returned at 41 µg/dL. The mother was instructed to avoid breastfeeding until her BLLs decreased to below 40 µg/dL, consistent with federal and local guidelines. The neonate was empirically chelated with dimercaptosuccinic acid. On postpartum day 2, maternal BLL decreased to 36 µg/dL, and the neonatal BLL was found to be 33 µg/mL. Both the mother and neonate were discharged to an alternative lead-free household on postpartum day 4.
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Affiliation(s)
- Sanjay Mohan
- Division of Medical Toxicology, Department of Emergency Medicine, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 270-05 76th Avenue, Queens, NY, 11040, USA.
| | - Sarah Mahonski
- Department of Emergency Medicine, SUNY Upstate Medical Center, Syracuse, NY, USA
| | - Christian Koziatek
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York City, NY, USA
| | - Emily T Cohen
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Silas Smith
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Mark K Su
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Bonglaisin JN, Kunsoan NB, Bonny P, Matchawe C, Tata BN, Nkeunen G, Mbofung CM. Geophagia: Benefits and potential toxicity to human—A review. Front Public Health 2022; 10:893831. [PMID: 35958861 PMCID: PMC9360771 DOI: 10.3389/fpubh.2022.893831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Geophagy is the habit of consuming clay soil such as chalk or kaolin. Though it is globally practiced, the safety of those involved is yet to be fully established. It is thought to be highly prevalent in pregnant women because of its antinausea or therapeutic effects. This practice is also thought to be provoked by some nutritional needs, but in modern society its etiology is obscure. The mineralogical and chemical compositions of clay may vary from one region to another and even in all form of rocks clay constitutes. Published articles in geophagy indicate lack of adequate investigations into the toxicity of geophagy, though it is globally practiced and more prevalent in Africa (as a continent) or in Africans migrants. Some studies have helped to identify some minerals that are toxic to human if ingested. In most cases, the potential toxicity emphasized by these studies is based on the detection of the presence of these nuisance elements in the geophagic materials. Scientifically, a lot has been done in the light of detection of toxic matter, but more investigations on metabolic studies are still necessary. The variability of clay content with respect to source motivated this review on geophagy and its potential toxicity to human. This review is aimed at bringing out findings that would enable a better understanding of the toxicity potential of geophagy across context and taxa.
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Affiliation(s)
- Julius Nsawir Bonglaisin
- Center for Food and Nutrition Research, Institute of Medical Research and Studies of Medicinal Plants (IMPM), Yaoundé, Cameroon
- *Correspondence: Julius Nsawir Bonglaisin
| | - Noella Bajia Kunsoan
- Centre for Transport and Logistics, “Sapienza” University of Rome, Rome, Italy
- Center for Research in Neurobiology, “Sapienza” University of Rome, Rome, Italy
| | - Patrice Bonny
- Center for Food and Nutrition Research, Institute of Medical Research and Studies of Medicinal Plants (IMPM), Yaoundé, Cameroon
| | - Chelea Matchawe
- Center for Food and Nutrition Research, Institute of Medical Research and Studies of Medicinal Plants (IMPM), Yaoundé, Cameroon
| | - Bridget Ndakoh Tata
- Center for Food and Nutrition Research, Institute of Medical Research and Studies of Medicinal Plants (IMPM), Yaoundé, Cameroon
| | - Gerard Nkeunen
- Department of Biochemistry, Faculty of Science, University of Dschang, Dschang, Cameroon
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Harris K, Mo A, Atmuri K. Desiderosmia: a manifestation of iron deficiency in pregnancy. BMJ Case Rep 2022; 15:e248220. [PMID: 35260407 PMCID: PMC8905916 DOI: 10.1136/bcr-2021-248220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/04/2022] Open
Abstract
A pregnant woman in her 20s presented with an excessive desire to smell a specific household cleaning product. She was found to have severe iron deficiency anaemia and her symptoms resolved following intravenous iron supplementation. She described symptoms of fatigue, shortness of breath and olfactory cravings. The specific scent could not be replicated with other smells and the woman had to significantly modify her lifestyle to accommodate the excessive desire. She had a similar experience during her prior pregnancy which resolved after the correction of severe iron deficiency anaemia. This unique symptom has been described as desiderosmia: iron deficiency manifesting as olfactory cravings. This underappreciated but useful symptom is defined as a separate entity to pica, as there is an absence of desire to ingest the product. Desiderosmia can harm mother and baby through inhalation of potentially harmful fumes; hence, women who describe this symptom should be assessed for iron deficiency anaemia.
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Affiliation(s)
- Katrina Harris
- Women's Health Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Allison Mo
- Clinical Haematology Unit, Monash Health, Clayton, Victoria, Australia
| | - Kiran Atmuri
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Markowitz ME, Mercedes J, Apt-Dudfield O. Chelation during sequential pregnancies: A case report with a twist. Obstet Med 2022; 15:54-55. [PMID: 35444729 PMCID: PMC9014553 DOI: 10.1177/1753495x20975623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
This report summarizes chelation management of lead poisoning occurring during sequential pregnancies. Several aspects make this case unusual; firstly recurrent lead poisoning, secondly treatment with succimer, the use of which is very rarely reported in pregnancy, and thirdly the presence of co-existent vitamin D deficiency and hyperparathyroidism, both potential contributors to bone lead release.
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Affiliation(s)
- Morri E Markowitz
- Morri E Markowitz, Montefiore Hospital and Medical
Center, 111 E 210th St Bronx, New York, NY 10467-2490, USA.
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Simmat-Durand L, Toutain S. [Life course violence, pregnancy experiences, use of alcohol and pemba, in French Guiana women]. Encephale 2020; 47:319-325. [PMID: 33189352 DOI: 10.1016/j.encep.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/28/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A survey was conducted in the maternity hospitals of French Guiana in 2017-2018 centered on uses of tobacco, alcohol and pemba (clay) during pregnancy, including questions about violence and the perception of adverse situations during pregnancy. The data used here allow an analysis of lifetime violence and the experience of the last pregnancy. METHODS An ad hoc questionnaire was designed including some questions to identify at risk situations and T-Ace items for measuring problematic alcohol use. It was adapted to specificities of the local population groups, migrants or from borders, and asking for the maternal tongue. It was administered to women following childbirth. The questionnaire was strictly anonymous. The ethics committee had validated the questionnaire and the collection procedures (Decision 2017-25). In addition, to the issue of violence, seven questions were asked about women's experiences with pregnancy. A bivariate analysis identified significantly associated variables that were used for a multicomponent analysis to identify a typology of women based on their pregnancy experience (Modalisa8 and SPSS19). The very small number of women who smoked tobacco or cannabis during pregnancy (16 and 7 women respectively) led us to ignore these variables. RESULTS The survey interviewed 789 women throughout Guyana. They were on average 28.9 years old at this pregnancy and had an average of 3.24 living children comprised this newborn. The questioned women were younger than in metropolitan France, less often married, with a low level of education, often foreigners, especially Haitian or Surinamese. Overall, 174 women, or 22% of the total reported having experienced violence in their lifetime, with four women refusing to answer the question. The profiles of the concerned women were not very different according to their ages or levels of education, but differed significantly from the average on several characteristics, such as their mother tongue, marital status, nationalities, whether living on state aid not related to employment or family allowances, or having no resources, living around Cayenne or Kourou and having been on the territory for less than two years. Three groups of women were distinguished by the multicomponent analysis. The first group comprised essentially foreign women living around Cayenne, alone with children, having a low educational level, and having experienced difficulties to cope with this pregnancy. They reported no use of psychoactive substances. They experienced violence more often than in the other groups (almost one in two). One in five had migrated during the last pregnancy. The second group was composed more often of French women, born in Guyana or in metropolitan France. They more often lived with a partner, had a good educational level, personal or marital incomes. They expressed more often worry, with sleep problems but with an entourage to rely on. Before pregnancy they drank alcohol at events but one in three had a T-Ace scoring at two or more. They had a good pregnancy follow-up. The last group was composed of women living around Saint-Laurent-du-Maroni or in remote communities, with a low educational level, living alone with numerous children. They didn't feel worry and had good sleep. They didn't experience violence. They differed by their use of pemba and beer and late or inadequate pregnancy follow-up. CONCLUSIONS Data on violence in French Guyana show that young people and women declare more often having experienced physical violence, in or out of family life. Young women are overrepresented thus a survey in childbearing women must reveal a high frequency of these events. Our data allow us to go further, by associating this experience of violence and the experience of pregnancy with socio-demographic variables. We can thus see that the overall average obtained on a large number of indicators is smoothed by extremely contrasting situations, of women feeling safe or not, well followed or not for this pregnancy, etc. The groups distinguished by the MCA reveal the contrast between women of Haitian nationality in the Cayenne region and Surinamese or Nengee-speaking women, who are grouped around Saint-Laurent-du-Maroni or in the isolated municipalities of western Guyana. One sub-group stands out in particular for the combination of lifetime violence and very unfavorable conditions during the last pregnancy, both of precariousness, isolation and recent migration. The experience of violence and pregnancy in poor conditions require close actions to take charge of these women, especially since they are at risk for sexually transmitted diseases, including HIV.
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Affiliation(s)
- L Simmat-Durand
- CERMES3, CNRS UMR 8211, Inserm U988, université de Paris, 45, rue des Saints-Pères, 75006 Paris, France.
| | - S Toutain
- CERMES3, CNRS UMR 8211, Inserm U988, université de Paris, 45, rue des Saints-Pères, 75006 Paris, France
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Simmat-Durand L, Toutain S. [Tabacco, alcohol and pemba consumption during pregnancy in French Guyana]. SANTE PUBLIQUE 2020; 31:771-783. [PMID: 32550659 DOI: 10.3917/spub.196.0771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The risks to the unborn child from maternal consumption of alcohol, tobacco and substances during pregnancy are well documented in the medical literature. Data on such consumption in Frensh Guyana are scattered and scarce, which prevents prevention policies from being adapted to the local context. METHOD To compensate for the inadequacy of the data, a questionnaire survey was conducted in 2017-2018 in Guyana's three maternity units with 789 mothers. Among other things, this survey aimed at gathering data about consumption, about information received on substance consumption during pregnancy, and about the interest of professionals met by the women in these matters. RESULTS Tobacco and alcohol consumption at the end of pregnancy were respectively 2% and 17%. Two profiles of alcohol consumers emerged: in Cayenne, French women with a high school level of education or more consuming on occasion wine and in Saint-Laurent-du-Maroni, regular beer consumers among women speaking a language of the river, born in Guyana. Finally, Pemba (clay) was used by 15% of the pregnant women. Although the percentage of smokers is much lower than that of metropolitan France, the percentage of alcohol consumers is significantly higher in Guyana. Women speaking in Creole and French or/and those with a high school level education and more would be less asked about their alcohol consumption. Finally, these women with a high school degree or more believe that they have had information about alcohol risk during school or through prevention campaigns, while those with a primary education level would have been better informed by health professionals. DISCUSSION The low tobacco consumption of women in Guyana is in line with that of all the FODs. Alcohol consumption during pregnancy seems slightly higher than in metropolitan France. Alcohol users have specific profiles, linked to the isolation of the municipality of residence, a low level of education, traditional consumption of Pemba and previous experience of miscarriage. The prevalence of Pemba use is a source of concern for professionals, especially when associated with beer consumption. Mobilization of local teams on the issue of alcohol during pregnancy is strong. However, professionals tend to interview women in lower Professions and Socioprofessional Categories, or PCS, more often, as in metropolitan France, with a level of education below the high school degree or whose mother tongue differs from French or French Creole.
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Ettinger AS, Egan KB, Homa DM, Brown MJ. Blood Lead Levels in U.S. Women of Childbearing Age, 1976-2016. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:17012. [PMID: 31944143 DOI: 10.1289/ehp5926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999-2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; 1μg/dL=0.0483μmol/L) in U.S. women 15-49 years of age between 1976 and 2016. For all women with valid BLLs (n=22,408), geometric mean (GM) BLLs and estimated prevalence of BLLs ≥5μg/dL were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs ≥10 and ≥20μg/dL were also calculated. RESULTS The most recent GM BLLs (2007-2010 and 2011-2016, respectively) were 0.81μg/dL [95% confidence interval (CI): 0.79, 0.84] and 0.61μg/dL (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976-1980, 1988-1991, and 1991-1994) were 10.37μg/dL (95% CI: 9.95, 10.79), 1.85μg/dL (95% CI: 1.75, 1.94), and 1.53μg/dL (95% CI: 1.45, 1.60), respectively. In 2011-2016, 0.7% of women of childbearing age had BLLs ≥5μg/dL, and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant. DISCUSSION Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925.
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Affiliation(s)
- Adrienne S Ettinger
- Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn B Egan
- Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jean Brown
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Ettinger AS, Egan KB, Homa DM, Brown MJ. Blood Lead Levels in U.S. Women of Childbearing Age, 1976-2016. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:17012. [PMID: 31944143 PMCID: PMC7015629 DOI: 10.1289/ehp5925] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/05/2019] [Accepted: 12/03/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Lead can adversely affect maternal and child health across a wide range of exposures; developing fetuses and breastfeeding infants may be particularly vulnerable. We describe the distribution of blood lead levels (BLLs) in U.S. women of childbearing age and associations with sociodemographic, reproductive, smoking, and housing characteristics over a 40-y period. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) II, NHANES III Phase I and Phase II, and 1999-2016 continuous NHANES were used to describe the distribution of BLLs (given in micrograms per deciliter; 1μg/dL=0.0483μmol/L) in U.S. women 15-49 years of age between 1976 and 2016. For all women with valid BLLs (n=22,408), geometric mean (GM) BLLs and estimated prevalence of BLLs ≥5μg/dL were calculated overall and by selected demographic characteristics. For NHANES II, estimated prevalence of BLLs ≥10 and ≥20μg/dL were also calculated. RESULTS The most recent GM BLLs (2007-2010 and 2011-2016, respectively) were 0.81μg/dL [95% confidence interval (CI): 0.79, 0.84] and 0.61μg/dL (95% CI: 0.59, 0.64). In comparison, GM BLLs in earlier periods (1976-1980, 1988-1991, and 1991-1994) were 10.37μg/dL (95% CI: 9.95, 10.79), 1.85μg/dL (95% CI: 1.75, 1.94), and 1.53μg/dL (95% CI: 1.45, 1.60), respectively. In 2011-2016, 0.7% of women of childbearing age had BLLs ≥5μg/dL, and higher BLLs were associated with older age, other race/ethnicity, birthplace outside the United States, four or more live births, exposure to secondhand tobacco smoke, and ever pregnant or not currently pregnant. DISCUSSION Lead exposure in U.S. women of childbearing age is generally low and has substantially decreased over this 40-y period. However, based on these estimates, there are still at least 500,000 U.S. women being exposed to lead at levels that may harm developing fetuses or breastfeeding infants. Identifying high-risk women who are or intend to become pregnant remains an important public health issue. https://doi.org/10.1289/EHP5925.
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Affiliation(s)
- Adrienne S. Ettinger
- Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn B. Egan
- Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David M. Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jean Brown
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Yamamoto SS, Premji SS, Nyanza EC, Jahanpour O. Investigating the association between stress. Anxiety and geophagy among pregnant women in mwanza, Tanzania. Appetite 2019; 142:104328. [PMID: 31238080 DOI: 10.1016/j.appet.2019.104328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/05/2018] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
Geophagy, the craving and intentional consumption of soil, is common especially among pregnant women in some low- and middle-income settings. Soils may contain a variety of non-nutritive components such as heavy metals and microbes or substances that interfere with gastrointestinal absorptive processes, posing health risks to pregnant women. Several hypotheses regarding the practice have been proposed but very few have examined the role of maternal stress. The practice of geophagy may help to alleviate stress or anxiety during gestation from perceived dietary or other pregnancy-related concerns. In this study, we evaluated several measures of maternal stress (general anxiety, Pregnancy-Related Anxiety Scores (10-item revised), and Perceived Stress Scores) and other covariates in relation to geophagic behaviour in early pregnancy in 227 women (12-19 weeks gestation) recruited from two hospitals in the Nyamagana district of Mwanza City, Tanzania. Geophagy was reported by 24.7% of the pregnant women. Using LASSO regression, self-reported treatment of nausea or vomiting during pregnancy (adjusted OR = 3.12, 95%CI: 1.43 to 6.83), paternal education level (adjusted OR = 2.79, 95%CI: 1.32 to 5.87 for primary or lower education level), antenatal hospital site (adjusted OR = 3.71, 95%CI: 1.78 to 7.75), prescription drug use prior to pregnancy (adjusted OR = 1.76, 95%CI: 0.87 to 3.56) and general anxiety (feeling worried, tense or anxious in the past four weeks) (adjusted OR = 1.81, 95%CI: 0.88 to 3.72) were associated with geophagic behaviour. Given that relatively little has been done to examine geophagy in relation to the public health risk it may pose to pregnant women, these findings suggest the need for further investigations regarding maternal stress.
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Affiliation(s)
- Shelby S Yamamoto
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405-87Ave, Edmonton, Alberta, T6G 1C9, Canada.
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, 313 HNES Building, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada.
| | - Elias C Nyanza
- Department of Environmental and Occupational Health, School of Public Health, Catholic University of Health and Allied Sciences, P.O. Box 1464, Bugando Area, Mwanza, Tanzania.
| | - Ola Jahanpour
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, P.O. Box 2240, Tanzania.
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Parnia A, Chakravartty D, Wiseman CLS, Archbold J, Copes R, Zawar N, Chen SX, Cole DC. Environmental factors associated with blood lead among newcomer women from South and East Asia in the Greater Toronto Area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 624:558-566. [PMID: 29268227 DOI: 10.1016/j.scitotenv.2017.11.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Newcomers bring with them histories of environmental exposure in their home countries and may have different sources of lead (Pb) exposure compared to other residents of their adopted country. AIMS To describe past and current factors associated with Pb exposure and blood Pb among South and East Asian newcomer women of reproductive age in the Greater Toronto Area (GTA), Ontario, Canada. METHODS In collaboration with public health units and community organizations a community-based research model was utilized by recruiting peer researchers to assist in all aspects of the study. Blood samples were taken and phone interviews were conducted. Canadian Health Measures Survey (CHMS) cycles 1, 2, and 3 data was used to contextualize the distribution blood Pb levels. Multiple regression was applied to log-transformed blood lead measurements, using a hierarchical model building process. RESULTS In total, 211 participants were recruited from Bangladesh, China, India, Pakistan and Sri Lanka. The distribution of the blood Pb varied by country of origin, and higher blood Pb values were found above 75th percentile compared to the CHMS. Distal factors significantly influencing blood Pb concentrations related to life history, such as duration of stay in Canada (RR=0.91; 95% CI 0.86-0.97), living near agricultural fields (RR=0.78; 95% CI 0.62-0.93), and country of origin. Proximal factors with significant contribution were use of cosmetics, traditional remedies, and smoking cigarettes. RECOMMENDATIONS Different past and current exposures may be important in various newcomer populations, informing international stakeholders, public health agencies, and primary care practitioners to adapt health education and exposure reduction programs to consider pre- and post-migration factors.
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Affiliation(s)
- Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Dolon Chakravartty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Clare L S Wiseman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
| | | | - Ray Copes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Noureen Zawar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shirley X Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; School of the Environment, University of Toronto, Toronto, Canada
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Kmiec I, Nguyen Y, Rouger C, Berger JL, Lambert D, Hentzien M, Lebrun D, Robbins A, Drame M, Bani-Sadr F. Factors Associated with Geophagy and Knowledge About Its Harmful Effects Among Native Sub-Saharan African, Caribbean and French Guiana HIV Patients Living in Northern France. AIDS Behav 2017; 21:3630-3635. [PMID: 28028652 DOI: 10.1007/s10461-016-1661-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Geophagy, or the ingestion of earth or clay, is widespread among women of Sub-Saharan African, Caribbean or French Guiana origin. Little is known about this practice among HIV patients native of these countries and who are followed-up in France. The aims of this study were to determine (i) the prevalence and factors associated with geophagy among HIV patients native of these countries, (ii) patients' knowledge about the harmful effects of geophagy, and (iii) the association of geophagy with iron deficiency, or a history of anemia or constipation. Among the 119 included patients, current geophagy and previous geophagy were present in 11/119 (9%) and 47/119 (40%) patients, respectively. Female gender was the only factor associated with consumption (OR 5.37; 95% CI 2.07-15.92 p = 0.001). Awareness about the risk of iron-deficient anemia was low (24%). Preventive education should be integrated into the care of HIV adults from countries in which geophagy is a culture and widely accepted practice.
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Pica is prevalent and strongly associated with iron deficiency among Hispanic pregnant women living in the United States. Appetite 2017; 120:163-170. [PMID: 28864256 DOI: 10.1016/j.appet.2017.08.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/17/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Anecdotal evidence suggests that pica occurs among Hispanic women in the United States, especially during pregnancy. However, the prevalence and socio-demographic and biological factors associated with pica in this population have not been adequately identified. METHODS Trained, bilingual study personnel conducted structured interviews at public health clinics in Salinas Valley, California with 187 pregnant Hispanic women in their 2nd or 3rd trimesters of pregnancy. Hemoglobin was measured using Hemocue; concentrations of transferrin receptor (TfR) and alpha-1 acid glycoprotein (AGP) were measured in dried blood spots. Multivariable stepwise regression analyses were conducted with pica during pregnancy as the dependent variable and individual- and family-level factors as independent variables to identify significant associations. Additionally, multivariable models were built to explore the associations between pica and iron status (iron deficiency and anemia). RESULTS Half of all participants (51.3%) had ever engaged in pica, and 37.6% had done so during the current pregnancy. Pica substances included large quantities of ice, frost, raw starches, and various earthen items. Pica during the current pregnancy was significantly associated with higher TfR concentrations [OR: 1.29; 95% CI: 1.11, 1.51] indicative of low iron stores and greater food insecurity [OR: 1.20, 95% CI: 1.03, 1.40]. Women who engaged in pica during the current pregnancy were more likely to be iron deficient [adjusted OR: 2.58; 95% CI: 1.19, 5.60], but not anemic [adjusted OR: 1.40; 0.60, 3.23]. CONCLUSIONS Among pregnant Hispanic women, pica was prevalent and strongly associated with iron deficiency and food insecurity. Clinicians should screen for pica during pregnancy in Hispanic populations, and future studies should elucidate the underlying etiology and consequences of engaging in pica during pregnancy.
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Chen SX, Wiseman CLS, Chakravartty D, Cole DC. Metal Concentrations in Newcomer Women and Environmental Exposures: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030277. [PMID: 28282863 PMCID: PMC5369113 DOI: 10.3390/ijerph14030277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/21/2017] [Accepted: 03/04/2017] [Indexed: 01/30/2023]
Abstract
Newcomer women from developing countries are recognized to be at risk for elevated exposures to environmental contaminants and associated negative health effects. As such, data on exposure sources and contaminant body burden concentrations is critical in the development of effective public health policies and interventions in support of newcomer health. We conducted a scoping review to gather evidence on important toxic metals of health concern, lead (Pb), mercury (Hg) and cadmium (Cd), and their concentrations and potential exposure sources among newcomer women. An initial 420 articles were identified through the databases MEDLINE, EMBASE and Scopus, many reporting by ethnicity rather than newcomer/immigrant status. Several articles reported metal concentrations for other biomarkers but did not include blood, nor stratify results. From the remainder, we selected a total of 10 articles for full textual review, which reported blood Pb, Hg or Cd levels for newcomer women and/or stratified blood metal results according to foreign birth or country of origin. Three of the articles reported higher Pb, Hg and Cd concentrations in newcomer women compared to their native-borne counterparts. Exposures identified as contributing to elevated Pb, Hg and Cd blood concentrations included: pica behaviour, the use of lead-glazed cookware or eye cosmetics, and fish/shellfish consumption. The review revealed a limited availability of data on metal body burden concentrations, exposure sources and routes among newcomer women specifically. More research is needed to better understand the extent to which newcomer women are disproportionately at risk of elevated metal exposures due to either country of origin or current exposures and to inform relevant, multi-national risk management strategies.
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Affiliation(s)
- Shirley X Chen
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
- School of the Environment, University of Toronto, 33 Willcocks Street, Toronto, ON M5S 3E8, Canada.
| | - Clare L S Wiseman
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
- School of the Environment, University of Toronto, 33 Willcocks Street, Toronto, ON M5S 3E8, Canada.
| | - Dolon Chakravartty
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada.
- School of the Environment, University of Toronto, 33 Willcocks Street, Toronto, ON M5S 3E8, Canada.
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Trends and consequences of consumption of food and non-food items (pica) by pregnant women in Western Kenya. NFS JOURNAL 2016. [DOI: 10.1016/j.nfs.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Intiful FD, Wiredu EK, Asare GA, Asante M, Adjei DN. Anaemia in pregnant adolescent girls with malaria and practicing pica. Pan Afr Med J 2016; 24:96. [PMID: 27642435 PMCID: PMC5012775 DOI: 10.11604/pamj.2016.24.96.9282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Pregnancy during the adolescent period is challenging mainly because of the nutritional demands of both the adolescent and pregnancy period. The risk for anaemia increases especially in developing countries such as Ghana where malaria is endemic and the practice of pica is common. In this study, we sought to determine the prevalence of anaemia, pica practice and malaria infection among pregnant adolescent girls and assess the extent to which these factors are associated. Methods Two hundred and sixty five (265) pregnant adolescent girls were recruited from three hospitals in Accra. Haemoglobin levels, malaria infection and the practice of pica were assessed. Pearson's Chi squared tests were used to determine associations and logistic regression analysis was used to determine the odds of being anaemic. Significance was set at p≤0.05. Results Anaemia prevalence was 76% with severity ranging from mild (47.8%) to severe (0.8%). About 27.5% were moderately anaemic. Pica was practiced in only 9.1% of the girls. Malaria infection was prevalent in 17.7% of the girls. The logistic regression analysis indicated that pregnant girls with malaria infection were 3.56 times more likely to be anaemic when compared to those without malaria. Also, those who practiced pica were 1.23 times more likely to be anaemic when compared to those who did not practice pica. Conclusion Anaemia is very prevalent in pregnant adolescent girls and is a public health problem. Drastic measures should be taken to reduce the high prevalence.
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Affiliation(s)
| | - Edwin Kwame Wiredu
- School of Biomedical and Allied Health Sciences, University of Ghana, Ghana
| | - George Awuku Asare
- School of Biomedical and Allied Health Sciences, University of Ghana, Ghana
| | - Matilda Asante
- School of Biomedical and Allied Health Sciences, University of Ghana, Ghana
| | - David Nana Adjei
- School of Biomedical and Allied Health Sciences, University of Ghana, Ghana
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Ezzeddin N, Zavoshy R, Noroozi M, Jahanihashemi H, Riseh SH. Prevalence and risk factors for pica during pregnancy in Tehran, Iran. Eat Weight Disord 2015; 20:457-63. [PMID: 26143570 DOI: 10.1007/s40519-015-0198-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Pica is an eating disorder characterized by the persistent ingestion of substances that the consumer does not define as food. The exact cause of pica is often unknown. The purpose of this study was to determine the prevalence of pica during pregnancy and its related risk factors. METHOD This cross-sectional study was carried out in health care centers in west of Tehran. Three hundred women were selected by stratified sampling method from the population. Demographic information and characteristics of pica during pregnancy, such as the kind, the onset, duration, frequency and the reasons, and also iron supplementation status before and during pregnancy and kind of infant feeding were collected via interview and questionnaire. The data were analyzed by chi square test and logistic regression in SPSS 16. RESULTS The prevalence of pica among the studied population was 8.33%, and pagophagia (ice and freezer frost) was the most common form of pica which is characterized by the ingestion of non-food substance (76%). Sixty-four percent of women reported practicing pica regularly on a daily basis. In this study, there was significant association between pica practice and education, unwanted pregnancy, pregnancy complications, the levels of economic satisfaction, iron supplementation during pregnancy, kind of infant feeding, and type of delivery. However, there was no significant association between pica and age, employment, pregnancy ranks, the history of abortions or stillbirths, infant sex, and iron supplementation before pregnancy. CONCLUSIONS Iron supplementation during pregnancy should be more considered. Also women with low education should be asked concerning pregnancy pica.
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Affiliation(s)
- Neda Ezzeddin
- Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rosa Zavoshy
- Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Hassan Jahanihashemi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shaghayegh Hadizadeh Riseh
- Department of Nutrition, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
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Low Levels of Awareness of Lead Hazards among Pregnant Women in a High Risk--Johannesburg Neighbourhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15022-7. [PMID: 26633431 PMCID: PMC4690904 DOI: 10.3390/ijerph121214968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
Background: The widespread use of lead and elevated risk of lead exposure in South African children justifies a need for high levels of awareness of the sources, exposure pathways, and measures to reduce this risk in children. This study aimed to determine the levels of knowledge of lead hazards among pregnant women in an area where children had already been established to be at a high risk of lead exposure and poisoning. Methods: Following informed consent, a structured questionnaire was administered to 119 pregnant women attending antenatal clinic services at Rahima Moosa Mother and Child Hospital, west of central Johannesburg. Questions were asked about social, demographic and residential characteristics, as well as knowledge, perceptions, behaviours and practices in relation to child lead hazards. Conclusion: Overall awareness of the dangers of lead in pregnancy was low (11%). Amongst those who had heard of it, only 15% thought that lead could cause detrimental health effects. A consequence of this low level of awareness of lead hazards is a high potential for the participants and their children to unwittingly be exposed to environmental lead from various sources, thereby undermining preventative approaches.
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Santos AM, Benute GRG, Nomura RMY, Santos NO, De Lucia MCS, Francisco RPV. Pica and Eating Attitudes: A Study of High-Risk Pregnancies. Matern Child Health J 2015; 20:577-82. [PMID: 26558792 DOI: 10.1007/s10995-015-1856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe and determine the association between the occurrence of pica and eating attitudes in women with high-risk pregnancies and to determine the prevalence of pica during pregnancy. METHODS A cross-sectional and prospective 24-month study was conducted with 913 women with high-risk pregnancies. Structured interviews were carried out and the Eating Attitudes Test was applied. RESULTS Pica was diagnosed in 5.7 % of the pregnant women, and its most commonly practiced type was geophagia (57.7 %). The association between pica and signs related to the eating attitudes: "to be considered too thin by others" (p < 0.02), and "to spend too much time thinking about food" (p = 0.05); and the association between pica and the risk of both anorexia nervosa and bulimia nervosa (p < 0.01) were statistically significant. CONCLUSIONS The absence of validated instruments in the literature for assessing pica reinforces the difficulty of investigating this practice and the need for further studies. Moreover, additional efforts need to focus in the improvement of screening for other eating disorders with obstetric consequences associated with pica and be incorporated into the routine of healthcare professionals.
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Affiliation(s)
- Amanda M Santos
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil.
| | - Gláucia R G Benute
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil.,Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roseli M Y Nomura
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil
| | - Niraldo O Santos
- Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Mara C S De Lucia
- Psychology Division, Clinics Hospital of Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rossana P V Francisco
- Department of Obstetrics and Gynecology, Clinics Hospital of Faculty of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155 - PAMB - Ground Floor, São Paulo, SP, 05403-000, Brazil
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Lin JW, Temple L, Trujillo C, Mejia‐Rodriquez F, Rosas LG, Fernald L, Young SL. Pica during pregnancy among Mexican-born women: a formative study. MATERNAL & CHILD NUTRITION 2015; 11:550-8. [PMID: 24784797 PMCID: PMC4216644 DOI: 10.1111/mcn.12120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although pica, the craving and purposive consumption of non-food substances, is common among many populations, especially during pregnancy, the health consequences are not well understood. Further, very little is known about pica among Mexican populations in the United States and Mexico. Therefore, we conducted formative research to understand pica in this understudied population. Our objectives were to identify the frequency and types of pica behaviours, to understand perceived aetiologies and consequences of pica and to ascertain if the behaviour was common enough to warrant a larger study. We held nine focus group discussions (three in the Salinas Valley, California; six in Xoxocotla, Morelos, Mexico) with 76 Mexican-born women who were currently pregnant or had delivered within the past 2 years. Earth, adobe, bean stones and ice were the most commonly reported pica substances. Twenty-eight of the 76 participants (37%) reported ever engaging in pica; 22 participants (29%) reported doing so during pregnancy. The proportion of women reporting pica in the United States and Mexico was 43% and 34%, respectively. Women attributed pica to the overwhelming organoleptic appeal of pica substances (especially smell and texture) and to micronutrient deficiencies. Perceived consequences of unfulfilled pica cravings were birthmarks or fetal loss; fulfilled pica cravings were also thought to be generally harmful to the mother or child, with several women specifying toxic lead, pesticides or 'worms'. In sum, pica among Mexican women is common enough to warrant a larger epidemiologic study of its sociodemographic correlates and physiological consequences.
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Affiliation(s)
- Janice W. Lin
- School of Public HealthUniversity of CaliforniaBerkeleyCaliforniaUSA
| | | | - Celina Trujillo
- School of Public HealthUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Fabiola Mejia‐Rodriquez
- Centro de Investigación en Nutrición y SaludInstituto Nacional de Salud PúblicaCuernevacaMorelosMexico
| | - Lisa Goldman Rosas
- Stanford Prevention Research CenterStanford UniversityPalo AltoCaliforniaUSA
| | - Lia Fernald
- School of Public HealthUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Sera L. Young
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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Feske SK, Goldberg M, Dudzinski DM, Gonzalez RG, Kovach AE. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 29-2015. A 38-Year-Old Pregnant Woman with Headache and Visual Symptoms. N Engl J Med 2015; 373:1154-64. [PMID: 26376139 DOI: 10.1056/nejmcpc1404335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Premji SS, Yim IS, Dosani (Mawji) A, Kanji Z, Sulaiman S, Musana JW, Samia P, Shaikh K, Letourneau N, MiGHT Group. Psychobiobehavioral Model for Preterm Birth in Pregnant Women in Low- and Middle-Income Countries. BIOMED RESEARCH INTERNATIONAL 2015; 2015:450309. [PMID: 26413524 PMCID: PMC4564601 DOI: 10.1155/2015/450309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/03/2015] [Indexed: 12/19/2022]
Abstract
Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in stress responses leading to PTB and explain the basis of this approach. We discuss ethical considerations for a psychosocial, biological, and behavioral screening tool to predict PTB from a LMI country perspective.
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Affiliation(s)
- Shahirose S. Premji
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, TRW Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
- O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, Canada T2N 4Z6
| | - Ilona S. Yim
- Department of Psychology and Social Behavior, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Aliyah Dosani (Mawji)
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, Canada T3E 6K6
| | - Zeenatkhanu Kanji
- School of Nursing and Midwifery, Aga Khan University-East Africa, Opposite Aga Khan Primary School Plot (9/11), Colonel Muammar Gaddafi Road, P.O. Box 8842, Kampala, Uganda
| | - Salima Sulaiman
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Joseph W. Musana
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, Aga Khan University-Nairobi, 3rd Parklands Avenue off Limuru Road, P.O. Box 30270, Nairobi 00100, Kenya
| | - Pauline Samia
- Department of Pediatrics, Aga Khan University-Nairobi, 2nd Parklands Avenue, East Tower Block, Room 505, Nairobi 00100, Kenya
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University-Karachi, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
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Ezzeddin N, Zavoshy R, Noroozi M, Sarichloo ME, Jahanihashemi H. The Association Between Postpartum Depression and Pica During Pregnancy. Glob J Health Sci 2015; 8:253-9. [PMID: 26573027 PMCID: PMC4873575 DOI: 10.5539/gjhs.v8n4p120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/18/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objectives: Postpartum depression (PPD) is a common disorder and social debilitating that has adverse effects on the mother, child and family. Pica is an eating disorder characterized by persistent ingestion of substances that the consumer does not define as food. The aim of this study was to investigate the association of postpartum depression with pica during pregnancy. Method: This is case-control study was carried out in health centers in west Tehran. 152 depressed women (case group) and 148 non-depressed women (control group) were selected randomly from these health care centers. In addition to collecting demographic and pica data, the Edinburgh Depression Scale was used. The data was analyzed by both descriptive and analytic analyses such as chi-squared and logistic regression in SPSS version 16. Result: In this study, there wasn’t a significant association between PPD and pica during pregnancy (P=0.153, OR=2.043, CI=0.767, 5.438), but, postpartum depression has a significant association with type (clay) (P= 0.024) and duration (more than 2 months) (P= 0.023) of pica practice. Conclusions: In the present study, pregnancy pica was not important risk factor for PPD but there were similar risk factors such as iron supplementation during and postpartum pregnancy with pica and PPD.
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Rabel A, Leitman SF, Miller JL. Ask about ice, then consider iron. J Am Assoc Nurse Pract 2015; 28:116-20. [PMID: 25943566 DOI: 10.1002/2327-6924.12268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The study aims to review a condition defined by the desire to consume ice in order to satisfy an addictive-like compulsion, rather than for purposes of hydration or pain relief. This condition is called ice pica, or pagophagia. Associations between ice pica and iron deficiency, suggestions for clinical screening of at risk populations, and recommendations for treatment and follow-up care are provided. DATA SOURCES An extensive literature review of original research articles, reviews, clinical practice manuscripts, and scientific publications on pica and pagophagia. CONCLUSIONS A compulsion or craving for the consumption of ice is often overlooked in clinical practice. It is therefore important for clinicians to include ice pica as part of the review of systems for certain patient populations. Ice pica is frequently associated with iron deficiency, and iron supplementation is an effective therapy in most cases. IMPLICATIONS FOR PRACTICE Knowledge gained from screening for ice pica can generate valuable patient information and lead to the diagnosis and treatment of iron deficiency. The populations at risk include young women and blood donors of either sex.
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Affiliation(s)
- Antoinette Rabel
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Susan F Leitman
- NIH Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Jeffery L Miller
- Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Orloff NC, Hormes JM. Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. Front Psychol 2014; 5:1076. [PMID: 25295023 PMCID: PMC4172095 DOI: 10.3389/fpsyg.2014.01076] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/08/2014] [Indexed: 12/20/2022] Open
Abstract
Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.
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Affiliation(s)
- Natalia C. Orloff
- Health Behaviors Laboratory, Department of Psychology, University at Albany – State University of New YorkAlbany, NY, USA
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Miao D, Young SL, Golden CD. A meta-analysis of pica and micronutrient status. Am J Hum Biol 2014; 27:84-93. [PMID: 25156147 DOI: 10.1002/ajhb.22598] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Pica is the craving for and consumption of nonfood items, including the ingestion of earth (geophagy), raw starch (amylophagy), and ice (pagophagy). Pica has long been associated with micronutrient deficiencies, but the strength of this relationship is unclear. We aimed to evaluate the association between pica behavior and the risk of being anemic or having low hemoglobin (Hb), hematocrit (Hct), or plasma zinc (Zn) concentrations. METHODS We systematically reviewed studies in which micronutrient levels were reported by pica status. We calculated the pooled odds ratio for anemia or weighted mean difference in Hb, Hct, or Zn concentrations between groups practicing or not practicing pica behaviors. RESULTS Forty-three studies including 6,407 individuals with pica behaviors and 10,277 controls were identified. Pica was associated with 2.35 times greater odds of anemia (95% CI: 1.94-2.85, P < 0.001), lower Hb concentration (-0.65 g/dl, 95% CI: -0.83 to -0.48 g/dl, P < 0.001), lower Hct concentration (-1.15%, 95% CI: -1.61 to -0.70%, P < 0.001), and lower Zn concentration (-34.3 μg/dl, 95% CI: -59.58 to -9.02 μg/dl, P = 0.008). Statistical significance persisted after excluding outliers and in subgroup analyses by pica type and life stage. CONCLUSION Pica is significantly associated with increased risk for anemia and low Hb, Hct, and plasma Zn. Although the direction of the causal relationship between pica and micronutrient deficiency is unknown, the magnitude of these relationships is comparable to other well-recognized causes of micronutrient deficiencies. Pica warrants greater public health attention; specifically the potential physiological mechanisms underpinning the relationship between pica and micronutrient deficiencies merit further study.
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Affiliation(s)
- Diana Miao
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, 02138
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Towards the prevention of lead exposure in South Africa: contemporary and emerging challenges. Neurotoxicology 2014; 45:220-3. [PMID: 25086205 DOI: 10.1016/j.neuro.2014.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 11/22/2022]
Abstract
The prevention of lead exposure continues to constitute a major public health challenge in developed countries. In well-resourced countries major lead exposure reduction interventions have resulted in significant improvements in childhood blood lead distributions. In developing countries on the other hand, while lead exposure and poisoning remain serious public health concerns, a range of prevailing factors and circumstances, such as poverty, a large informal sector, competing public health challenges, low levels of awareness of lead hazards and weak capacity to enforce legislation, contribute to an increase in the scale and intensity of the challenge, and limit the prospects of comparable success in the foreseeable future. This paper collates available information to illustrate that despite some progress, a wide range of sources of lead exist in South Africa, and that certain settings and groups continue to be at high risk of lead exposure. Lead exposure in relation to paint, mining, lead melting in subsistence fishing communities, the consumption of Ayurvedic medicines and food production is described, and discussed with regard to the key factors hindering efforts to prevent lead poisoning and exposure in South Africa and many other developing countries.
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Song JE, Ahn JA. Effect of Intervention Programs for Improving Maternal Adaptation in Korea: Systematic Review. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2013; 19:129-141. [PMID: 37684759 DOI: 10.4069/kjwhn.2013.19.3.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the current state of nursing intervention for maternal adaptation and its' effectiveness in Korea by utilizing a systematic review. METHODS The PICO(Population-Intervention-Compar ator-Outcome) strategy was established, and 1,720 pieces of literature published during the last ten-year period from four electronic databases were reviewed. Eighteen references that met inclusion and exclusion criteria were finally selected for systematic review. The quality of references using critical appraisal checklist for experimental studies were evaluated, and then systematic review and meta-analysis were conducted. RESULTS All 18 references were quasi-experimental research design. Most interventions were provided at the hospital and postpartum care center. Maternal adaptation interventions appeared to be of many types, and particularly maternal role education programs were the most common. Confidence in maternal role was used as the most common variable for the maternal adaptati on. Various interventions for helping maternal adaptation in the postnatal period improved maternal confidence, moth er-infant attachment, maternal satisfaction and mother-infant interaction effectively. CONCLUSION A diversity of nursin g interventions in postnatal period improved various aspects of maternal adaptation. Randomized controlled trials and longitudinal studies are needed in order to verify the effect of interventions for maternal adaptation more clearly.
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Affiliation(s)
- Ju Eun Song
- College of Nursing, Ajou University, Suwon, Korea
| | - Jeong Ah Ahn
- College of Nursing, Ajou University, Suwon, Korea
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