Zahedan, a city situated in Sistan and Baluchestan province, located in the eastern border of Iran. A survey of the thirty health care centers in Zahedan City was done to select the centers for current study. For this study Zahedan City was considered as five zones divisions (north, south, east and west and center). Five health care centers were selected based on their acceptance and willingness to extend support for the study.

The sample size was determined using the formula,; where “n” is estimated sample size; “z” is the critical z score based on the desired degree of confidence; “p” is the prevalence rate and is the desired margin of error. Based on Mortazavi and Mohammadian [10] , a prevalence rate of 15% was chosen. Finally, a value of 200 was obtained to represent the target population.

The selected pregnant women were followed up to the third trimester ending in child birth. The inclusion criteria were age group (18 - 40 years) and having common health care visit during the three trimesters of pregnancy in selected women. The pregnant women with diabetes mellitus and cardiovascular disease (CVD) were excluded from the study. The study was approved by Human Ethical Committee of the University of Medical Science. A written consent to participate in the study was obtained from each subject. The study was carried out in the year 2011 to 2012.

Subjects were asked about their habits of eating clay or dirt, ice, starch, raw rice, or other food or nonfood substances during pregnancy period, and food craving as compulsive and elected ingestion of food substance at least once a day. A food substance was defined as any substance that can be digested and metabolized to give energy and build tissue. Compulsive ingestion of ice raw rice, and starch were classified as pica rather than food craving.

Gestational age was derived from last menstrual period or ultrasound. Maternal blood was analyzed for their hemoglobin and serum ferritin levels during the three trimesters of pregnancy.

Blood samples were collected from pregnant women during the end of each trimester of pregnancy period. The blood was drawn in the morning between 8 and 11 am. While in an upright position, the tourniquet was applied for a few seconds, and the venous blood was drawn by means of venipuncture (vacutainer system with multiple sample needles was used). The usual precaution of selecting an easily accessible vein in the anticubital fossa and applying the minimum of venous stasis was observed. A total of 10 cc of blood was collected from each volunteer, and immediately 7 cc of it was transferred into a clean, screw-capped glass tube without anticoagulant and allowed to stand at room temperature until the separation of the serum was started by centrifugation at 4˚C, at a speed of 3000 rpm. The separated sera were kept at −20˚C until analyses were done. Analysis were done at the Imam Reza Hospital Lab, Mashhad Before the analysis, the separated frozen sera were placed at room temperature to allow thawing, and then were mixed. The analyzed parameters included hemoglobin (g/dL) and ferritin (ng/mL). Hemoglobin and Serum ferritin levels were analyzed in the hospital laboratory by cyanomethemoglobin method and Elisa method (on a fully automated Eliza plate reader; Best 2000) respectively.

Anthropometric measurements of neonates, namely weight, height and head circumferences, were taken within 24 hours after birth, using standard procedure [11] [12] . A beam balance by an accuracy of 50 g was employed for weighing the infants. Infants were weighted, with minimum clothing while they were restful. The infant- meter was used for measuring the recumbent length of the newborn infant. A lightweight fiberglass infant-meter was used to measure length up to 100 cm. Infants were laid on the board of the infant-meter, which was kept on a flat table. The crown of the head was in the contact with the top end of the device. The knee was extended, so that the feet were at right angles to the leg. The mobile device was then brought in contact with the feet of neonate. This distance between the two right angle devices was measured. The reading was recorded in centimeters with an accuracy of 0.5 cm. The infant’s head was steadied and the greatest circumference measured, by placing the fiberglass tape firmly round the frontal bones, just supra-orbital ridges. The tape was passed round the head at the same level, on each side, and laying it over the maximum occipital prominence on the back.

Statistical Package for Social Sciences (SPSS, version 11.5) was used to analyze the data. Frequencies and descriptive statistics (Percentages, means and standard deviations) were generated for variables. The independent t-test was used to determine a difference between the two groups (namely with pica and without pica groups). P value of less than 0.05 was considered as significance level.

Table 2 presents dietary behaviors among the subjects in terms of pica practice, food craving and avoidance in each trimester. Our finding showed a decrease in prevalence of pica and food craving with increase of each trimester of pregnancy (Table 2). The highest prevalence of pica (17.5%) observed in the first trimester of pregnancy, while the lowest prevalence (5.6%) was observed in the third trimester of pregnancy (Table 2).

Common forms of pica practice were ice (53.7%), clay eating (23.3%), ice and freezer frost (11.5%) and other items (11.5%) (Table 3). Reasons associated with the pica practice included prevention of salivation, nausea and vomiting. Food craving was also a common practice among the pregnant women, with a greater number of the pregnant women (59.7%) craving for at least one food item during the first trimester of pregnancy. Food craving during the second and third trimesters of pregnancy were 54.2% and 40.7% respectively. Foods commonly craved for included sweet items (20.4%), chocolate (19.7%), candies (12.6%), and ice cream (15.3%). Surprisingly quite a large number of the women (18.7%) craved for cereal products or foods belonging to starchy roots. The reasons expressed by the pregnant women for food craving were for satisfaction and to prevent either nausea or vomiting. Food avoidance in the first trimester was reported by 50.7% of the women. In the second trimester, food avoidance was reported among 46.1% while 47.6% avoided certain foods in the third trimester. The avoided foods included meat and fish, eggs and milk, green leafy vegetables and cereals, and greasy foods. Reasons associated with food avoidance were the taste or smell of food, feeling of nausea or vomiting and texture of food.

Hemoglobin levels during the three trimesters of pregnancy in pica and without pica groups were as follows; (10.8 g/dL vs. 12.1 g/dL, 10.4 g/dL vs. 10.6 g/dL and 10.5 g/dL vs. 11.8 g/dL respectively) (Table 4). Ferritin levels in pica and without pica groups during the three trimesters of pregnancy periods were 64.3 ng/mL vs.70.3 ng/mL; 61.0 ng/mL vs. 69.1 ng/mL and 63.9 ng/mL vs. 70.4 ng/mL respectively (Table 4).

Anthropometric measurements of the neonates born from mothers with pica and mothers without pica, namely birth weight, height, head circumference and gestational age showed mean 3.211 kg, 49.1 cm, 31.0 cm, 39.2 wk and 3.430 kg, 50.0 cm, 34.0 cm, 39.5 wk respectively (Table 5).