In 2013, a 35-year-old pregnant woman walked into a St. Louis hospital and told her doctor she was unusually weak and dizzy.
These symptoms began a month before, and they got worse and worse. By the time the woman went to the hospital, she was 37 weeks pregnant. But at the hospital, the woman’s troubles only increased. Her heart rate, already irregular, got faster and faster. Doctors admitted her to the intensive care unit and started her on an intravenous drip full of fluids and electrolytes; the woman’s potassium levels were dangerously low. Potassium is an important electrolyte that’s essential for the normal function of the brain, nerves, and muscles. Low potassium, or hypokalemia, can cause a number of problems, including weakness, cramping, fatigue, constipation, and, in serious cases, heart problems. The woman’s situation was getting more serious by the hour, as detailed in a case study published in the medical journal Obstetrics & Gynecology. Doctors not only had to figure out what was causing the woman’s symptoms, they had to make sure to save the baby. It soon became clear that the woman’s heart muscle was weakened, a condition known as peripartum cardiomyopathy. This disorder only occurs in about 1,000 to 1,300 women in the U.S. every year, and no one knows what causes it.
There was no question that the woman had peripartum cardiomyopathy, but that still didn’t explain her terribly low levels of potassium.
Her health care team gave her medications to treat the heart condition and turned their attention to the infant. They induced the woman and she gave birth to a healthy son. He weighed 5 pounds, 4 ounces, and, thankfully, did not appear to have suffered from his mother’s health scare. Two days later, she provided the clue that explained her entire condition. She had been eating huge amounts of baking soda for years, she explained. This craving proved to be a terrible danger to the woman and her child. “Eating large amounts of baking soda (which contains sodium bicarbonate) can lead to severe electrolyte disturbances, muscle breakdown and ultimately heart failure or cardiomyopathy,” Miami-based TopLine OBGYN Sarah Bedell, MD, tells HealthyWay. At first, the sick woman’s box-a-day habit was a self-administered treatment for hiccups, but when she got pregnant, it became a craving. Anyone who’s ever been pregnant understands that you end up craving some weird foods, but this woman’s pregnancy craving put her life—and the life of her baby—in danger. Fortunately, once she quit eating baking soda, her potassium levels evened out, and she got healthy enough to go home with her brand new baby boy. Here’s the thing, though: This woman’s case was not the first of its kind. The literature shows at least two similar cases, in which pregnant women crave baking soda, eventually eating so much of it that they develop health problems.
The condition is called pica, and it’s often associated with pregnancy.
Not everyone who develops pica craves baking soda exclusively. People with pica end up with all sorts of strange cravings for non-food substances.
In many cases, cravings can be difficult to overcome.
“Pica is defined as the persistent eating of non-nutritious substances that are typically not considered food for at least one month,” says Bedell. “Examples of substances commonly consumed with this condition include ice, starch, earth, chalk, charcoal, toilet paper, baby powder and coffee grounds.” Incidence rates of pica in the United States are between 14 and 44 percent, although that includes every form of the disorder, not just pregnancy-related pica. One study of 128 pregnant women found that 38 percent of the participants developed pica before giving birth. Pica cravings occur in fewer than 25 to 30 percent of pregnant women, reports the American Pregnancy Association. But one study of 128 pregnant women found that 38 percent of the participants developed pica before giving birth. Unfortunately, though, many doctors assume that only a fraction of their patients with pica are stepping forward for treatment. “Compulsive eating, especially of inedible objects, can be a source of considerable embarrassment or ridicule,” points out a chapter in the medical textbook Clinical Methods: The History, Physical, and Laboratory Examinations. “Hence, only a few patients come to the physician complaining of their unusual eating habit.” There’s reason to believe the practice may be more widespread than the statistics show. That’s just another reason why, if you develop pica, you shouldn’t feel ashamed about it. But what, exactly, could lead to a craving for dirt or ashes? As the American Pregnancy Association says, “Don’t panic. It happens and is not abnormal.”
Although researchers have yet to pinpoint the cause of pica, most associate it with a little-known vitamin or mineral shortage.
Unfortunately, this condition is part of the mystery of human health, and there isn’t one specific explanation that can tell the whole story. “Eating clay or soil, which contain several minerals, could provide a way for the body to replenish low levels of these nutrients,” says Bedell. “This theory is imperfect, however, as several consumed substances (ice, toilet paper, etc) have minimal or no nutritional value.” One article in the Journal of the Academy of Nutrition and Dietetics associates pica with an iron deficiency (also known as anemia). That’s something Bedell has seen in her own practice. Bedell explains that “pica is often associated with anemia, which results from low blood counts or low iron stores in the body. This makes pregnant patients particularly susceptible, as anemia is commonly seen in pregnancy. Low levels of zinc have also been associated with pica.” According to Clinical Methods, even slight iron deficiencies, not severe enough to earn the label “anemia,” have been associated with pica. “In fact,” the book reports, “A pica may be detected in as many as 50 percent of all persons with iron deficiency.”
Pica in pregnancy, as well as cravings in general, are common.
Whether patients lack iron, zinc, or some other mineral—and this probably goes without saying—there are far healthier ways to get enough vitamins and minerals than eating dirt. In fact, depending on the severity of the pica, sufferers like the woman in the above story can easily place their health at risk. For pregnant women with pica, those health risks also apply to their unborn child. The American Pregnancy Association warns that “eating non-food substances is potentially harmful to both you and your baby. Eating non-food substances may interfere with the nutrient absorption of healthy food substances and actually cause a deficiency. Pica cravings are also a concern because non-food items may contain toxic or parasitic ingredients.” However, if you do find yourself giving into odd cravings for dirt or soap while pregnant, don’t think that you’ve completely lost your mind. Remember, that study found a nearly 40 percent rate of pica among pregnant women. It’s not good for you, but you aren’t alone. “Patients should be reassured that pica in pregnancy, as well as cravings in general, are common,” Bedell reminds us. She continues, “Treatment should focus on safety. Treating possible underlying causes, such as anemia, with iron should be attempted, but may not always stop cravings. Of course, eating dangerous materials should be stopped immediately.” That’s not always as easy as it seems, though, Bedell explains. “In many cases, cravings can be difficult to overcome,” she says.
So if you are pregnant and you find yourself craving dirt…
Listen to the American Pregnancy Association when they say: “Don’t panic. It happens and is not abnormal.”
Most women who experience pica for a short period of time do not experience any adverse effects.
So what should you do if you suspect you have pica while you’re pregnant? “If you think you are suffering from pica you should discuss this with your OBGYN as soon as possible, so it can be discussed if what you are consuming is harmful,” Bedell says. She also recommends contacting “your local Poison Control Center if you think you have consumed something that poses immediate danger.” A healthcare professional can walk you through the risks of these strange cravings. For many women, that alone is enough to help them beat the temptation to grab a big bite of dirt. You can also monitor your iron levels and make sure you get enough vitamins and minerals. Introduce dark, leafy greens and lots of beans in your diet. Even white rice supplies a lot of iron. Whatever iron-rich food you prefer, be sure to eat lots of it. Sufficient iron might help to prevent pica from developing in the first place. You can also provide yourself with alternatives to giving into your cravings. Try carrying sugar-free gum everywhere you go. If you feel a craving coming on, start chewing your gum until the temptation passes. “Patients should try to substitute what they are eating with something that has similar qualities but is less harmful. For example, women who crave rubber can try chewing gum instead, and those who crave soil or clay can substitute oatmeal,” says Bedell. Finally, the American Pregnancy Association recommends telling a friend what you’re going through. That friend can “help you avoid non-food items,” according to the APA website. “In most circumstances, pica is not dangerous. Most women who experience pica for a short period of time do not experience any adverse effects. However, depending on the type and amount of substance being consumed, pica can lead to serious health consequences,” says Bedell. “Poor outcomes are usually seen if repeated consumption occurs over time.” Whatever you do, don’t start eating boxes and boxes of baking soda every day. We’ve seen where that path leads, and it is frightening.