Project Summary – Dr. Leila Larson

Project summary:

Our study used a randomized trial to determine the effects of supplementation with iron on pica behaviors among anemic pregnant women in rural and urban Malawi. We hypothesized that, among anemic pregnant women supplementation with iron would cause a decrease in the prevalence of all non-food cravings and geophaphic behaviors in particular. We compared changes in the prevalence of pica, and all types of pica (i.e., geophagy, amylophagy, pagophagy), among 862 pregnant women from their second to their third trimester who were randomized to receive either intravenous iron (i.e., a single dose of ferric carboxymaltose Vifor Pharma at 20 mg/kg up to 1000mg) or the standard-of-care oral iron tablets.

At enrolment, the prevalence of any pica was 71.7%. Hemoglobin and ferritin concentrations were lower among participants with geophagy compared to those without geophagy. This trend was consistent at enrolment and at 4 weeks post-treatment. Hemoglobin and ferritin concentrations, however, were not different among participants with and without other types of pica. From enrolment to 4 weeks post-treatment, prevalence of any pica decreased, but the decrease was not differential by treatment group (ferric carboxymaltose: 57.3% vs standard-of-care: 63.0%, prevalence ratio [PR]=0.93 [95% CI 0.83–1.06], p=0.28). There was, however, a reduction in the prevalence of geophagy (i.e., the craving and consumption of earth) in women randomly assigned to ferric carboxymaltose compared to the standard-of-care (ferric carboxymaltose: 12.9% vs standard-of-care: 22.3%, PR=0.53 [95% CI 0.39–0.72], p<0.0001). No effects were observed on amylophagy, pagophagy, or other pica.

The larger reduction in geophagy among women who received ferric carboxymaltose vs standard-of-care was concurrent with a large reduction in iron deficiency and moderate reduction in anemia in this same study population.