671: Prevalence of and risk factors for pica among pregnant women in Chhattisgarh, India

Abstract

670 Racial disparities in perinatal mortality at 40, 41 and 42 weeks of gestation Anita C.J. Ravelli, Jelle Schaaf, Martine Eskes, Esteriek de Miranda, Ameen Abu Hanna, Ben Willem J. Mol Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Obstetrics and Gynecology, Amsterdam, Netherlands, Academic Medical Center, Medical Informatics, Amsterdam, Netherlands, Academic Medical Center, Obstetrics & Gynaecology, Amsterdam, Netherlands, Academic Medical Center, Obstetrics & Gynecology, Amsterdam, Netherlands OBJECTIVE: Normal duration of pregnancy has long been thought to have a uniform distribution over all different racial groups. We hypothesize that the normality of pregnancy duration is race specific, which urges the need of a tailored approach of the management post term pregnancy. STUDY DESIGN: We used data from the nation wide Perinatal Registry Netherlands from 1999 till 2008. All singleton infants born from 40 0/7 weeks of gestation onwards without congenital anomalies of the four main racial groups were included. We used logistic regression analysis to assess both crude and adjusted perinatal mortality, which is a combination of fetal and neonatal mortality within 7 days after birth. RESULTS: The overall perinatal mortality was 1586 in 755,615 infants; 2.1 per 1000. Perinatal mortality risk was 1.9 per 1000 at 40 weeks and increased to 2.4 at 41 weeks and 2.3 at 42 weeks, which was significantly different from 40 weeks (p 0.001). Overall, the South Asian, African/Creole and Mediterranean women had increased risk of perinatal mortality compared to Caucasian women (adjusted odds ratios 2.5 95% CI 1.5-4.2, 1.8 95% CI 1.2-2.8 and 1.6 95% CI 1.3-2.1, respectively). South Asian and African women delivered earlier than Caucasian women (p 0.001). South Asian women had significantly increased risks of perinatal mortality especially at 41 weeks of gestation (9.2 per 1000). African/Creole women risks were increased at both 40 and 41 weeks (2.6 and 4.4 per 1000 respectively). Mediterranean women had significantly increased risk of perinatal mortality at both 41 and 42 weeks (4.3 and 2.7 per 1000 respectively). When the analysis was restricted to spontaneous onset of labor the same patterns emerged (see figure). CONCLUSION: South Asian, African/Creole and Mediterranean women have increased risk of perinatal mortality from 40 weeks onwards. South Asian and African/Creole have a shorter duration of pregnancy as compared to Caucasian women. These data suggest that induction of labor for post term pregnancy should be considered at a younger gestational age for non-Caucasian women. 671 Prevalence of and risk factors for pica among pregnant women in Chhattisgarh, India Adeline Boatin, Blair Wylie, Mrigendra Pal Singh, Neeru Singh, Kojo Yeboah-Antwi, Davidson Hamer Massachusetts General Hospital, OB/GYN, Boston, MA, Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, National Institute for Malaria Research Field Station, National Institute for Malaria Research Field Station, Madhya Pradesh, India, Center for Global Health and Development, Center for Global Health and Development, Boston, MA OBJECTIVE: Pica refers to the ingestion or craving for nonfood items such as soil, clay or chalk. Reported prevalence in pregnancy has varied widely (e.g., 0.02% Denmark; 74% Kenya). Studies have demonstrated an association between pica and iron deficiency anemia although whether pica is a cause or consequence remains uncertain. An increase in parasitic infections, electrolyte disturbances and gastrointestinal complications has also been linked with pica. We sought to determine the prevalence of pica, identify risk factors, and evaluate the association with anemia among pregnant women in India. STUDY DESIGN: In 2 districts in Chhattisgarh, India, 2386 pregnant women were enrolled during routine antenatal visits over 12 months (2007-08) to assess malaria prevalence. Information about pica was collected and blood was obtained by fingerstick for hemoglobin (Hgb) determination. RESULTS: Approximately one-quarter (637/2386, 27%) of the subjects reported the consumption of chalk, mud-pot or raw rice during pregnancy. Moderate to severe anemia (Hgb 9 g/dL) was quite common in the population (23%) but significantly higher among those with pica (30.9% vs 20.5%, p 0.0001). Risk factors for pica included fewer years of education (p 0.001), engagement in agricultural work (p 0.01), and membership among historically disadvantaged castes (Scheduled Caste, Scheduled Tribals) (p 0.0001). In addition, pica was more frequent among women who chewed tobacco compared with those who did not (46.5% vs 24.6%, p 0.0001). Age, parity, home ownership, use of iron supplements, malaria parasitemia, chronic disease, and smoking were not associated with pica. CONCLUSION: Pica was relatively common among this cohort of Indian pregnant women and significantly associated with anemia. Identified risk factors suggest a link with socioeconomic status. Given these findings, further observational and qualitative research is needed to clarify maternal behaviors and the potential impact of pica on maternal and fetal health.