The craving of pregnant women for strange foods is termed pica. Worldwide, its prevalence is estimated to be 30 percent (Fawcett, 2016). At times, nonfoods such as ice-pagophagia, starch-amylophagia, or clay-geophagia may predominate. This desire is considered by some to be triggered by severe iron deficiency. Although such cravings usually abate after deficiency correction, not all pregnant women with pica are iron deficient. Indeed, if strange "foods" dominate the diet, iron deficiency will be aggravated or will develop eventually.
Patel and coworkers (2004) prospectively completed a dietary inventory on more than 3000 women during the second trimester. The prevalence of pica was 4 percent. The most common nonfood items ingested were starch in 64 percent, dirt in 14 percent, sourdough in 9 percent, and ice in 5 percent. he prevalence of anemia was 15 percent in women with pica compared with 6 percent in those without it. Interestingly, the rate of spontaneous preterm birth before 35 weeks was twice as high in women with pica.
Women during pregnancy are occasionally distressed by profuse salivation-pyalism. Although usually unexplained, ptyalism sometimes appears to follow salivary gland stimulation by the ingestion of starch.
At least 5 percent of pregnancies are estimated to be complicated by new-onset or new-type headache (Spierings, 2016). Common headaches are virtually universal. Acetaminophen is suitable for most of these, and an in-depth discussion is found in Chapter 60 (p. 1057).
Low back pain to some extent is reported by nearly 70 percent of gravidas (Liddle, 2015; Wang, 2004). Minor degrees follow excessive strain or significant bending, lifting, or walking. It can be reduced by squatting rather than bending when reaching down, by using a back-support pillow when sitting, and by avoiding high-heeled shoes. Back pain complaints increase with progressing gestation and are more prevalent in obese women and those with a history of low back pain. In some cases, troublesome pain may persist for years after the pregnancy (Noren, 2002).
Severe back pain should not be attributed simply to pregnancy until a thorough orthopedic examination has been conducted. Severe pain has other uncommon causes that include pregnancy-associated osteoporosis, disc disease, vertebral osteoarthritis, or septic arthritis (Smith, 2008). More commonly, muscular spasm and tenderness are classiied clinically as acute strain or ibrositis. Although evidence-based clinical research directing care in pregnancy is limited, low back pain usually responds well to analgesics, heat, and rest. Acetaminophen may be used chronically as needed. Nonsteroidal antiinlammatory drugs may also be beneicial but are used only in short courses to avoid fetal efects (Chap. 12, p. 241). Muscle relaxants that include cyclobenzaprine or baclofen may be added when needed. Once acute pain is improved, stabilizing and strengthening exercises provided by physical therapy help improve spine and hip stability, which is essential for the increased load of pregnancy. For some, a support belt that stabilizes the sacroiliac joint may be helpful (Gutke, 2015).