Effects of Ferric Carboxymaltose on Pica among Pregnant Women in Malawi: A Substudy to a Randomized Controlled Trial.

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: This study provides causal evidence that geophagy is reduced by improvements in iron status and anemia during pregnancy.

Trial registration number: This trial was registered at www.anzctr.org.au as ACTRN12618001268235.