Effects of ferric carboxymaltose on pica among pregnant women in Malawi: a sub-study to a randomized controlled trial
- Author(s)
- Larson, LM; Mwangi, M; Harding, R; Moya, E; Ataíde, R; Mzembe, G; Thurber, A; Young, SL; Braat, S; Phiri, K; Pasricha, SR;
- Journal Title
- Journal of Nutrition
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND: Pica is the craving and consumption of non-food 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. OBJECTIVE: We leveraged the randomized trial of intravenous iron for anemia in Malawian pregnant women (REVAMP) to determine the effects of iron therapy, compared to 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 randomized 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 weeks post-randomization 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 two weeks. 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 to standard-of-care oral iron and were lower among participants with geophagy. From baseline to 4 weeks post-randomization, the prevalence of geophagy decreased more among women assigned to FCM compared to standard-of-care (FCM: 33.5% to 12.9%, standard-of-care: 30.4% to 22.3%, prevalence ratio (PR) =0.53 [95% CI 0.39-0.72], p<0.0001). There was no evidence of a treatment effect for overall pica (FCM: 70.7% to 57.3%, standard-of-care: 72.6% to 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: ACTRN12618001268235.
- Keywords
- anemia; geophagy; iron; pica; pregnancy
- Department(s)
- Haematology
- Publisher's Version
- https://doi.org/10.1016/j.tjnut.2025.05.010
- Open Access at Publisher's Site
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Creation Date: 2025-06-02 07:40:43
Last Modified: 2025-06-02 07:41:12