Re: The clinical term for a certain psychotic condition during pregnancy?

Dear Ed-

I'm not so sure about the violent images part, but the second part of your question, about cravings for nonfood substances during pregnancy, is called pica. Pica is defined as the consumption of nonfood items, such as dirt, laundry starch, even freezer ice and pennies, and can effect many groups of people, including pregnant women.

Pica can be common in pregnant women and is correlated with other family members who exhibit pica and/or pica in the woman's childhood (1,4). Pica is also common among women in Africa and Latin America, and is considered a normal practice during pregnancy (2,3,5). Pica can also be found, however, in patients with neurological disorders, where pica can be a life-threatening illness, due to ingestion of toxic substances or perforation of the intestine by ingested substances (6,7).

Although the cause of pica in pregnant women is unknown, it is often associated with low iron and zinc levels in the blood, so it has been proposed that pica is an attempt by the pregnant woman to correct nutritional deficiencies (8-11). It is controversial, however, whether ingestion of nonfood items positively contributes to the nutritional status of the woman (12). On the negative side, pica in pregnant women can result in lead poisoning, hypokalemic myopathy (low potassium causing muscle problems) from eating clay, parasite infections, and gestational diabetes due to overconsumption of starch (13-18).

A good general paper, available on the CDC's website, is Eating Dirt by Gerald N. Callahan. A web search for "pica" will also pull up a series of sites with information on pica.

Hope this helps!
ILD
MadScientist

References:

1) J Am Board Fam Pract. 2000 Sep-Oct;13(5):353-8. Pica: common but commonly missed. Rose EA, Porcerelli JH, Neale AV.
2) Soc Sci Med. 1999 Apr;48(8):1069-79. Perceptions of soil-eating and anaemia among pregnant women on the Kenyan coast. Geissler PW, Prince RJ, Levene M, Poda C, Beckerleg SE, Mutemi W, Shulman CE.
3) Niger J Med. 2001 Jan-Mar;10(1):25-7. Pica in pregnant women in Zaria, Nigeria. Sule S, Madugu HN.
4) South Med J. 1995 Dec;88(12):1236-40. Pica in a rural obstetric population. Smulian JC, Motiwala S, Sigman RK.
5) Environ Health Perspect. 2004 Feb;112(2):222-5. An unexplained case of elevated blood lead in a Hispanic child. Lowry LK, Cherry DC, Brady CF, Huggins B, D'Sa AM, Levin JL.
6) J Appl Behav Anal. 2002 Fall;35(3):233-46. Varying response effort in the treatment of pica maintained by automatic reinforcement. Piazza CC, Roane HS, Keeney KM, Boney BR, Abt KA.
7) Am J Hematol. 2001 Feb;66(2):126-9. Case report of sideroblastic anemia caused by ingestion of coins. Kumar A, Jazieh AR.
8) Nurse Pract. 1992 Nov;17(11):68, 71-4. A guide to primary care of iron-deficiency anemia. Bushnell FK.
9) J Nutr. 1994 Jun;124(6 Suppl):954S-962S. Pica in an urban environment. Edwards CH, Johnson AA, Knight EM, Oyemade UJ, Cole OJ, Westney OE, Jones S, Laryea H, Westney LS.
10) J Am Diet Assoc. 1998 Mar;98(3):293-6. Pica practices of pregnant women are associated with lower maternal hemoglobin level at delivery. Rainville AJ.
11)Indian J Pediatr. 2003 Feb;70(2):139-43. Low plasma zinc and iron in pica. Singhi S, Ravishanker R, Singhi P, Nath R.
12) Public Health Nutr. 2000 Dec;3(4):375-83. The impact of consuming iron from non-food sources on iron status in developing countries. Harvey PW, Dexter PB, Darnton-Hill I.
13) Obstet Gynecol. 2003 Nov;102(5 Pt 2):1169-71. Hypokalemic myopathy in pregnancy caused by clay ingestion. Ukaonu C, Hill DA, Christensen F.
14) Southeast Asian J Trop Med Public Health. 2003 Mar;34(1):7-15. A seroepidemiological study of toxocariasis and risk factors for infection in children in Sri Lanka. Iddawela DR, Kumarasiri PV, de Wijesundera MS.
15) Ambul Pediatr. 2003 Jan-Feb;3(1):37-9. Severe lead poisoning in pregnancy. Shannon M.
16) J Urban Health. 2002 Jun;79(2):225-37. Lead poisoning among pregnant women in New York City: risk factors and screening practices. Klitzman S, Sharma A, Nicaj L, Vitkevich R, Leighton J.
17) J Natl Med Assoc. 2001 Sep;93(9):317-9. Neonatal lead poisoning from maternal pica behavior during pregnancy. Hamilton S, Rothenberg SJ, Khan FA, Manalo M, Norris KC. 18) Arch Fam Med. 2000 Jul;9(7):649-52. Amylophagia presenting as gestational diabetes. Jackson WC, Martin JP.