Examining Pica in NYC Pregnant Women with Elevated Blood Lead Levels

We sought to describe the impact of pica, the craving for and intentional ingestion of substances not defined as food, as
a risk factor for lead poisoning in New York City (NYC) pregnant women. In order to describe pregnant women with elevated
blood lead levels (BLLs) who report pica, NYC health department data from 491 cases of lead-poisoned pregnant women from January
2001 to June 2009 were reviewed. Descriptive frequencies were obtained for women reporting pica. Data were compared between
women reporting and not reporting pica. In NYC, of the 43 (9%) lead-poisoned pregnant women reporting pica, 42 (97.7%) were
immigrants and 28 (64.6%) had consumed soil. Compared to lead-poisoned pregnant women not reporting pica, women reporting
pica had higher peak BLLs (29.5 vs. 23.8 μg/dL, P = 0.0001), were more likely to have had a BLL ≥ 45 μg/dL (OR = 3.3, 95% CI, 1.25, 8.68) and receive chelation (OR = 10.88,
95% CI, 1.49, 79.25), more likely to have emigrated from Mexico (OR = 3.05, 95% CI, 1.38–6.72), and less likely to have completed
high school (OR = indeterminate; 0 vs. 34%; P = 0.003). Among NYC lead-poisoned pregnant women, pica was associated with higher peak BLLs. Providers in NYC, and possibly
other urban settings, should be vigilant and question pregnant women, especially immigrants, about pica and strongly consider
testing this at-risk population for lead poisoning.