Larson Leila M, Mwangi Martin, Harding Rebecca, Moya Ernest, Ataíde Ricardo, Mzembe Glory, Thurber Ashley, Young Sera L, Braat Sabine, Phiri Kamija, Pasricha Sant-Rayn
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
Training and Research Unit of Excellence, Blantyre, Malawi; Department of Public Health, School of Public and Global Health, Kamuzu University of Health Sciences, Blantyre, Malawi; The Micronutrient Forum, Healthy Mothers Healthy Babies Consortium, Washington, DC, United States.
J Nutr. 2025 Jul;155(7):2398-2405. doi: 10.1016/j.tjnut.2025.05.010. Epub 2025 May 12.
Pica is the craving and consumption of nonfood items, and includes the ingestion of earth, raw starch, and ice. Pica is common in sub-Saharan Africa, especially during pregnancy. Despite being ubiquitous, its etiology is not well understood.
We leveraged the randomized trial of intravenous iron for anemia in Malawian pregnant women (REVAMP) to determine the effects of iron therapy, compared with standard-of-care oral iron, on pica among anemic pregnant women.
REVAMP was an open-label, individually randomized controlled trial, conducted in Malawi. A total of 862 pregnant anemic women in their second trimester were randomly assigned at baseline to receive either 1) a single dose of ferric carboxymaltose (FCM) or 2) standard-of-care oral iron. Pica was assessed at baseline and 4 wk postrandomization by asking participants whether they had craved and consumed earth (geophagy), unripe mango (amylophagy), raw rice (amylophagy), ice (pagophagy), ash, charcoal, or chalk in the past 2 wk. Venous blood was collected for hemoglobin and ferritin concentrations. A longitudinal Poisson model was used to examine the treatment effect of FCM on overall pica and types of pica.
At baseline, the prevalence of any pica was 71.7%, and geophagy was 31.9%. Hemoglobin and ferritin concentrations improved following FCM compared with standard-of-care oral iron and were lower among participants with geophagy. From baseline to 4 wk post randomization, the prevalence of geophagy decreased more among women assigned to FCM compared with standard of care [FCM: 33.5%-12.9%, standard of care: 30.4%-22.3%, prevalence ratio (PR) = 0.53 (95% confidence interval: 0.39, 0.72), P < 0.0001]. There was no evidence of a treatment effect for overall pica [FCM: 70.7%-57.3%, standard of care: 72.6%-63.0%, PR = 0.93 (0.83, 1.06)], amylophagy, or pagophagy.
This study provides causal evidence that geophagy is reduced by improvements in iron status and anemia during pregnancy.
This trial was registered at www.anzctr.org.au as ACTRN12618001268235.
异食癖是对非食物物品的强烈渴望和食用，包括吞食泥土、生淀粉和冰块。异食癖在撒哈拉以南非洲很常见，尤其是在孕期。尽管普遍存在，但其病因尚不清楚。
我们利用马拉维孕妇贫血静脉铁剂随机试验（REVAMP）来确定铁剂治疗与标准口服铁剂相比，对贫血孕妇异食癖的影响。
REVAMP是在马拉维进行的一项开放标签、个体随机对照试验。共有862名孕中期贫血孕妇在基线时被随机分配接受以下两种治疗之一：1）单剂量羧基麦芽糖铁（FCM）或2）标准口服铁剂。通过询问参与者在过去2周内是否有对泥土（食土癖）、未成熟芒果（食淀粉癖）、生米（食淀粉癖）、冰（食冰癖）、灰、木炭或粉笔的渴望和食用情况，在基线和随机分组后4周评估异食癖。采集静脉血检测血红蛋白和铁蛋白浓度。使用纵向泊松模型来检验FCM对总体异食癖和异食癖类型的治疗效果。
在基线时，任何异食癖的患病率为71.7%，食土癖为31.9%。与标准口服铁剂相比，FCM治疗后血红蛋白和铁蛋白浓度有所改善，且食土癖参与者的浓度较低。从基线到随机分组后4周，与标准治疗相比，分配到FCM组的女性食土癖患病率下降得更多[FCM组：33.5%-12.9%，标准治疗组：30.4%-22.3%，患病率比（PR）=0.53（95%置信区间：0.39，0.72），P<0.0001]。没有证据表明FCM对总体异食癖、食淀粉癖或食冰癖有治疗效果[FCM组：70.7%-57.3%，标准治疗组：72.6%-63.0%，PR=0.93（0.83，1.06）]。
本研究提供了因果证据，表明孕期铁状态和贫血状况的改善可减少食土癖。
