A 21-year-old woman, gravida 1 para 0, comes to the office for a prenatal visit at 16 weeks gestation. The patient, who has not gained weight since her last visit 4 weeks ago, has occasional nausea with vomiting twice a week. She has little appetite, which she attributes to mild indigestion, and her food consumption has decreased. However, the patient craves ice and has been consuming it throughout the day for the last few months. Medications include daily prenatal vitamins. The patient was prescribed twice-daily iron for anemia but does not take it because it causes constipation. She has no diarrhea, dysuria, chills, or fever. She does not use tobacco. Uterine fundus is consistent with a 16-week pregnancy. Fetal heart tone is 140-149/min. The patient's vital signs are within normal limits. Which of the following is the most likely diagnosis?

Question

A 21-year-old woman, gravida 1 para 0, comes to the office for a prenatal visit at 16 weeks gestation.  The patient, who has not gained weight since her last visit 4 weeks ago, has occasional nausea with vomiting twice a week.  She has little appetite, which she attributes to mild indigestion, and her food consumption has decreased.  However, the patient craves ice and has been consuming it throughout the day for the last few months.  Medications include daily prenatal vitamins.  The patient was prescribed twice-daily iron for anemia but does not take it because it causes constipation.  She has no diarrhea, dysuria, chills, or fever.  She does not use tobacco.  Uterine fundus is consistent with a 16-week pregnancy.  Fetal heart tone is 140-149/min.  The patient's vital signs are within normal limits.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Pica is the compulsive consumption of nonstaple food or non-nutritive substance for ≥1 month. It is most commonly seen in pregnant women and schoolchildren. The ingested substance is not a culturally accepted food source, and the consumption is not appropriate to the person's developmental level. Although the cause of pica is unclear, it is often, but not always, associated with nutritional deficiencies, including iron and zinc deficiencies and anemia of any etiology, such as in this patient. The 3 main types of materials consumed are earth/soil-rich substances, raw starch such as flour or cornstarch, and ice. Ice is the most common, but many people ingest more than one substance. (Choice A) Patients with anorexia nervosa restrict their energy intake to maintain a body weight below a minimal level for age, sex, and developmental trajectory (typical BMI <18.5 kg/m²). Anorexia nervosa is also associated with a distorted body image and intense fear of weight gain, which this woman does not have. (Choice B) Avoidant/restrictive food intake disorder is the avoidance of eating due to unpleasant sensations (eg, taste, texture, smell) associated with a particular foodstuff or fear of the consequences of eating (eg, fear of choking or vomiting). (Choice C) Bulimia nervosa involves episodes of binge eating followed by behaviors to compensate for weight gain (eg, vomiting, fasting, use of diuretics and/or laxatives). These episodes occur at least once a week for 3 months. (Choice D) Hyperemesis gravidarum is a severe form of persistent nausea and vomiting in pregnancy and can lead to weight loss and electrolyte imbalances. This patient has only mild nausea and vomiting, consistent with normal morning sickness. (Choice E) In cravings of normal pregnancy, the patient desires nutritive food items. The cravings in pica are for nonstaple food substances and tend to be much harder to resist. Educational objective: Pica is the compulsive consumption of a non-nutritive and/or nonstaple food. It is common in pregnancy and is often associated with iron deficiency anemia and other forms of nutritional deficiency. __________ References: A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period. (http://www.ncbi.nlm.nih.gov/pubmed/26892693) A meta-analysis of pica and micronutrient status. (http://www.ncbi.nlm.nih.gov/pubmed/25156147)

A 21-Year-Old Woman, Gravida 1 Para 0, Comes to the Office