Q. I recently learned that one of my ED patients, who is 3 months pregnant, has a strong affinity for ice and admits to eating ice cubes nearly all day. Should we be concerned about this? (L., Amarillo, TX)
A. This person may have a form of pica. The DSM-5 defines pica as eating non-nutritive, non-food substances over a period of at least one month. Incidentally, the word pica comes from the Latin, pica-pica, for magpie, due to the bird’s curiosity and habit of eating all types of substances.
Risks for developing pica come from a wide range of causes, including stress, cultural factors, learned behavior, low socioeconomic status, an underlying mental health disorder, nutritional deficiency (including iron or zinc deficiency), neglect as a child, pregnancy, epilepsy, and familial psychopathology, to name a few. Ice ingestion, or pagophagia, can be specifically associated with iron deficiency, especially during pregnancy. Other complications include tooth decay and sensitivity. According to Dr. Yasser Al Nasser and colleagues at King Faisel University, Al-Hofuf, Saudi Arabia, primary prevention should be used to identify at-risk patients, such as children who live in old homes that may contain lead-based paint, and pregnancy. This could be achieved by screening for the condition among such populations (StatPearls [Internet]; StatPearls Publishing, Treasure Island, FL ; January 2021).
Currently there are no medications for pica, and it is usually a benign disorder if it has recently developed. Careful screening of the materials ingested will be needed to assess risks. Ingested materials can contain a wide variety of toxic contaminants, such as lead, mercury, arsenic, and fluoride. Exposure to these toxins can lead to a wide range of effects, including lead poisoning. Lead poisoning can lead to dire consequences, particularly among pregnant women, and high levels can result in seizures. Careful assessment for iron deficiency is needed.
In most pregnant women and in children, the condition spontaneously disappears without any sequelae. However, in intellectually impaired persons, pica may persist for years. When pica is long-term, it can result in bowel obstruction, bezoars, and even serious toxicity.