La géophagie : avancées dans la compréhension de ses causes et conséquences

INCIDENCE, CAUSES, AND RISK FACTORS OF STILLBIRTH IN AN AMAZONIAN CONTEXT: SAINT LAURENT DU MARONI MATERNITY WARD 2016-2021

Objective

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors.

Study design

A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed.

Results

Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30 kg/m² (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained.

Conclusion

Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Kaolin consumption in pregnant women: what impact on the weight of newborns?

BACKGROUND

Geophagy is an ancestral practice particularly found among African women who describe beneficial effects on the sympathetic signs of pregnancy. Studies have reported a significant prevalence of consumption of kaolin, known as geophagy, within migrant population. However, this behavior, like other environmental factors, could lead to obstetrical and neonatal risks.

OBJECTIVE

The objective of our study was to evaluate the obstetrical and neonatal impact of kaolin consumption, especially on Z-SCORE for weight-for-gestational age in the newborn.

METHODS

This mono-centric historical cohort study was carried out on the basis of questionnaires and patients' obstetrical records. It was conducted between January 1 and July 1, 2017. Patients were divided into two groups: 1) women who consumed kaolin (at least once during their pregnancy), and 2) women who did not consume kaolin. Morphometric characteristics of the newborn were retrieved in obstetrical records.

RESULTS

Results: 105 pregnant women were included: 26 exposed and 79 non exposed. Women who consumed kaolin were more frequently without social protection at their first consultation (p < .01). Multivariate analysis did not show a significant association between Z-SCORE for weight-for gestational age in the newborn and kaolin consumption (β = 0.13, p = .54) after adjusting on age, precariousness, BMI, intake of toxic substances, anemia and beginning eclampsia. Among these covariates, precariousness was significantly associated with both a decrease in Z-SCORE for weight (β = -0.87, p < .002) and size (β = -0.68, p < .01).

CONCLUSION

Geophagy is not to be neglected in socially advantaged countries due to increased immigration. This study found no association between kaolin consumption and birth weight. However, there was a correlation between precariousness and low birth weight which reinforces the importance of tightening the follow-up during pregnancies in the most precarious women.

[Tabacco, alcohol and pemba consumption during pregnancy in French Guyana]

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.

Postpartum hemorrhage: incidence, risk factors, and causes in Western French Guiana

INTRODUCTION

Postpartum hemorrhage remains the leading cause of maternal death in France. Parturients in western French Guiana have specific sociodemographic features and a high rate of pathological pregnancies. The objective of this study was to determine the incidence of immediate postpartum hemorrhage (IPPH) in western French Guiana, and to describe the etiologies and risk factors.

METHODS

A case control study with incident cases was conducted in the Maternity Department of the Western French Guiana Hospital over a period of one year. The cases included women giving birth to a child of 22 weeks' GA and/or a child weighing 500 g, and who presented with IPPH. Two control subjects were included per case (after pairing for mode of delivery). The data were collected by questionnaire and from medical records. Multivariate analyses by logistic regression were conducted.

RESULTS

154 cases and 308 controls were included. The incidence rate of IPPH was 6.7%. The primary etiologies were: atony, placenta retention, and cervico-vaginal lesions. The factors associated with IPPH were: past history of IPPH (ORadj = 3.36 [1.65-6.87]), pre-eclampsia (ORadj = 2.56 [1.07-6.14]), labor induction by oxytocin (ORadj = 2.03 [1.03-3.99]), the absence of managed placental delivery (ORadj = 2.46 [1.24-4.91]), a gap of more than 30 min between birth and placental delivery (ORadj = 10.92 [2.17-54.99]), and macrosomia (ORadj = 6.38 [1.97-20.67]).

CONCLUSION

The incidence rate of IPPH is similar to that found in metropolitan France and in the literature. The risk factors identified here will enable the development of appropriate preventive protocols.

Healing and edible clays: a review of basic concepts, benefits and risks

The use of clay by humans for medicinal and wellness purposes is most probably as old as mankind. Within minerals, due to its ubiquitous occurrence in nature and easy availability, clay was the first to be used and is still used worldwide. Healing clays have been traditionally used by man for therapeutic, nutritional and skin care purposes, but they could impart some important health and skin care risks. For instance, clay particles could adsorb and make available for elimination or excretion any potential toxic elements or toxins being ingested or produced, but they could adsorb and make available for incorporation, through ingestion or through dermal absorption, toxic elements, e.g. heavy metals. Edible clays, a particular case of healing clays, have been traditionally used by man for nutritional and therapeutic purposes. Geophagy, the deliberate soil eating, earth eating, clay eating and pica (medical condition or eating disorder shown by individuals addicted to eat earth substances), has been observed in all parts of the world since antiquity, reflecting cultural practice, religious belief and physiological needs, be they nutritional (dietary supplementation) or as a remedy for disease. This paper pretends to review historical data, basic concepts and functions, as well as benefits and risks of the use of healing clays, in general, for therapeutic and cosmetic purposes, and of edible clays, in particular, for therapeutic purposes.

Interpreting habits in a new place: Migrants' descriptions of geophagia during pregnancy

BACKGROUND AND INTRODUCTION

Previous studies of soil eating, or geophagia, among pregnant women in sub-Saharan Africa indicate the practice is widespread. Various explanations have been explored to explain the global phenomenon of soil eating, with the most compelling explanation focused on clay's ability to prevent or treat intestinal infection. The urban South African context for clay eating is not well understood. This paper explores clay consumption amongst pregnant migrants who are nationals of countries where clay consumption may be common.

METHODS

I conducted in-depth interviews with a purposively selected group of Somali, Congolese, and Zimbabwean women (n = 23). Interviews included questions broadly related to maternal and infant nutrition. In addition, I conducted nine focus group discussions (n = 48) with adult Somali, Congolese (DRC), and Zimbabwean men (N = 3) and women (N = 6), segregated by country of origin and gender. This paper focuses specifically on responses related to geophagia.

RESULTS

While Somali women did not report consuming clay or charcoal, Congolese and Zimbabwean participants self-reported commonly consuming clay during pregnancy, and at times also when not pregnant. Despite having heard public health messaging that discouraged the practice, participants largely did not describe this consumption in terms of health, but rather in terms of craving and habit. Participants described continued consumption of clay in South Africa, and the only reason for ceasing consumption was in cases of severe constipation.

DISCUSSION

The widespread consumption of clay soil by Congolese and Zimbabwean women during pregnancy may be a mechanism through which identity was reasserted and reproduced in a foreign country. Participants' emphasis on clay consumption seemed related to the absence or expense of other craved foods, and perhaps also to feelings of loss in Cape Town.