Dietary cravings pregnancy1’ 2 Ernest
B. Hook,
and
aversions
M.D.
ABSTRACT
Interviews
undertaken coffee
or alcoholic
during
pregnancy. was
factors
were
because
For
the
but
cravings
were
and
Foods
fish.
The
main
reason
cited were
Journal
of Clinical
Nutrition
the
decrease
in
were
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1355/4655818 by Washington University, Law School Library user on 03 July 2018
alcoholic
for
beverages,
ingested
and
cravings these
less
candy
foods
associated
e.g.,
or infant endogenous
to concern for
(particularly poultry,
factors
predominantly
attributed
Other
meats,
changes
although
drank
in ingestion
maternal
frequently,
primarily
were
drop
regarding
were
regularly
to “endogenous”
the beverage.
sweets,
who
a significant
Concern
also
for
31: 1355-1362,
31: AUGUST
reported
pregnancy
during
of women
consumption,
a craving
ice cream,
changes
primarily
beverage.
outnumbered
The development of aversions to or crayings for ingested items during pregnancy is a well-known phenomenon. Pica for clay or starch for example, has been extensively investigated in many populations particularly in the southern United States, although the cause of these (or other cravings) during pregnancy are still not well understood. (1). Despite the fact that there is an extensive awareness of the changes in desires for nutritional items during pregnancy, there has been, to my knowledge, no previous quantitative study of the development of food aversions, and only one small such study of cravings for foods during pregnancy. The present study arose out of an investigation that primarily focused upon the subtle teratogenic effects of cigarette smoking (2). After discovery of significant changes in this habit during pregnancy, primarily a decrease, an investigation of beverage ingestion was also undertaken (3), since coffee and alcohol consumption are known to be associated with smoking. Many women reported significant aversions to coffee and alcoholic beverages early in pregnancy, and a craving for milk. These were, many reported, unrelated to physician’s advice or maternal concern about the infant or course of pregnancy. Rather, in many cases they were related to the devel-
30%
attributed
was in milk
explanations Nutr.
for
for
only
dietary to beverages,
almost
beverages
increase
cited
J. Clin.
regard was
of taste
aversions
Possible Am.
concerning
With
change
Soda
mothers
for which
women
to conception, this
frequent
frequently
oregano.
discussed.
prior coffee
mentioned.
many
250 delivery.
or a loss
most
also
of dieting.
the infant,
with
items
of nausea
health
of after
immediately
provocation
The American
during
which
chocolate), and with
sauces pregnancy
for
specific fruits, flavored are
1978.
opment of clinical symptoms in response to the beverages, such as nausea and vomiting of pregnancy, or simply to changes in a desire (or “taste”) for the beverage in question (3). It was then decided to undertake systematic study ofall food (and nonfood) items ingested during the entire pregnancy in another sample of women. Materials
and
methods
From March 6, 1975 to May 20, 1975 250 women who had delivered a liveborn infant were interviewed by a single observer at two local hospitals. These mothers were selected from a total of 847 women who had delivered a liveborn infant at the two hospitals during this period. Because of a wish to avoid provoking additional difficulty for those whose pregnancy had just ended with a catastrophic outcome, interviews were limited to mothers of ostensibly normal infants. That is, mothers of stillbirths or of infants placed in the intensive care unit were excluded. There was no other specific selection procedure except that the mothers were those available for interview on a weekday but before they left the hospital. Comparisons between our sample and all
From
the Epidemiology
and
Human
Ecology
Sec-
tion, Birth Defects Institute, Division of Laboratories and Research, New York State Department of Health and Department of Pediatrics, Albany Medical College, Albany, New York. 2 Supported in part by a grant from the National Institute of Child
1978,
pp.
1355-1362.
Health
Printed
and
Human
in U.S.A.
Development.
1355
HOOK
1356
mothers giving birth to hiveborns at these two hospitals during study in the time frame appear in Table 1. Mothers were first asked (in random starting order) concerning changes in the first half of their pregnancy for any of the seven specific beverages listed in Tables 2 and 3. They were also queried specifically concerning the reasons for any changes. They were then queried in an unstructured manner (i.e., without mentioning specific items) concerning cravings or aversions for other foods (or nonfood items) that may have developed at any time in their pregnancy.
Results The data in Table 1 indicate that there were no significant differences between the mothers sampled and the entire group delivering liveborn infants at the two hospitals with regard to race, maternal age, or reported years of schooling (a rough index of socioeconomic status). The mothers queried were not, of course, a representative sample in that mothers of infants with catastrophic outcomes were excluded, but the latter comprised only about 2% of the total of all livebirths at the time in question. Thus there is no reason to believe that inclusion of the latter category in the sample would have markedly changed the distribution of total preferences expressed. (It is possible of course that the small group of mothers in the latter category would have expressed a significantly different set of preferences. This possibility is under investigation in a separate ongoing prospective investigation of mothers in early pregnancy.) The data on changes in consumption in the seven beverages appear in Table 2. In Tables 3 and 4 are listed the reasons for the decreases and increases that were reported. In Tables 5 and 6 appear data on the frequency of cravings and aversions for other food items during pregnancy. Because of the great range in replies concerning specific food items, tabulating these systematically proved difficult. The results of the specific food cravings and aversions, as far as these could be distinguished, appear in TableS. The first footnote of Table 5 explains the scoring system used in this analysis. In Table 6 data on some grouped categories are presented. Discussion Concerning the significant fraction,
seven beverages queried, a at least a quarter, of the
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1355/4655818 by Washington University, Law School Library user on 03 July 2018
TABLE I Comparison of selected characteristics of the study population with mothers of all hivebirths at the two hospitals in the study Study
Mothers of all Iivebirths
population 250
No.
847 %
Race White Black Other Not stated Total
87.2 11.6 1.2
Six
of
100.0
0.8 13.6 28.0 36.0 16.4 4.0 0.8 0 0.4 100.0
0.7 15.5 30.0 35.7 13.4 4.3 0.5 0 0.1 100.2’
1.6 10.0 9.2
0.9 12.4 8.2
in years
Mother’s education schooling completedY 8 8-10 11 12 12 Not stated TotaY a
b
0.4 100.0
or unknown
Maternal age
B. Hook,
and
aversions
M.D.
ABSTRACT
Interviews
undertaken coffee
or alcoholic
during
pregnancy. was
factors
were
because
For
the
but
cravings
were
and
Foods
fish.
The
main
reason
cited were
Journal
of Clinical
Nutrition
the
decrease
in
were
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1355/4655818 by Washington University, Law School Library user on 03 July 2018
alcoholic
for
beverages,
ingested
and
cravings these
less
candy
foods
associated
e.g.,
or infant endogenous
to concern for
(particularly poultry,
factors
predominantly
attributed
Other
meats,
changes
although
drank
in ingestion
maternal
frequently,
primarily
were
drop
regarding
were
regularly
to “endogenous”
the beverage.
sweets,
who
a significant
Concern
also
for
31: 1355-1362,
31: AUGUST
reported
pregnancy
during
of women
consumption,
a craving
ice cream,
changes
primarily
beverage.
outnumbered
The development of aversions to or crayings for ingested items during pregnancy is a well-known phenomenon. Pica for clay or starch for example, has been extensively investigated in many populations particularly in the southern United States, although the cause of these (or other cravings) during pregnancy are still not well understood. (1). Despite the fact that there is an extensive awareness of the changes in desires for nutritional items during pregnancy, there has been, to my knowledge, no previous quantitative study of the development of food aversions, and only one small such study of cravings for foods during pregnancy. The present study arose out of an investigation that primarily focused upon the subtle teratogenic effects of cigarette smoking (2). After discovery of significant changes in this habit during pregnancy, primarily a decrease, an investigation of beverage ingestion was also undertaken (3), since coffee and alcohol consumption are known to be associated with smoking. Many women reported significant aversions to coffee and alcoholic beverages early in pregnancy, and a craving for milk. These were, many reported, unrelated to physician’s advice or maternal concern about the infant or course of pregnancy. Rather, in many cases they were related to the devel-
30%
attributed
was in milk
explanations Nutr.
for
for
only
dietary to beverages,
almost
beverages
increase
cited
J. Clin.
regard was
of taste
aversions
Possible Am.
concerning
With
change
Soda
mothers
for which
women
to conception, this
frequent
frequently
oregano.
discussed.
prior coffee
mentioned.
many
250 delivery.
or a loss
most
also
of dieting.
the infant,
with
items
of nausea
health
of after
immediately
provocation
The American
during
which
chocolate), and with
sauces pregnancy
for
specific fruits, flavored are
1978.
opment of clinical symptoms in response to the beverages, such as nausea and vomiting of pregnancy, or simply to changes in a desire (or “taste”) for the beverage in question (3). It was then decided to undertake systematic study ofall food (and nonfood) items ingested during the entire pregnancy in another sample of women. Materials
and
methods
From March 6, 1975 to May 20, 1975 250 women who had delivered a liveborn infant were interviewed by a single observer at two local hospitals. These mothers were selected from a total of 847 women who had delivered a liveborn infant at the two hospitals during this period. Because of a wish to avoid provoking additional difficulty for those whose pregnancy had just ended with a catastrophic outcome, interviews were limited to mothers of ostensibly normal infants. That is, mothers of stillbirths or of infants placed in the intensive care unit were excluded. There was no other specific selection procedure except that the mothers were those available for interview on a weekday but before they left the hospital. Comparisons between our sample and all
From
the Epidemiology
and
Human
Ecology
Sec-
tion, Birth Defects Institute, Division of Laboratories and Research, New York State Department of Health and Department of Pediatrics, Albany Medical College, Albany, New York. 2 Supported in part by a grant from the National Institute of Child
1978,
pp.
1355-1362.
Health
Printed
and
Human
in U.S.A.
Development.
1355
HOOK
1356
mothers giving birth to hiveborns at these two hospitals during study in the time frame appear in Table 1. Mothers were first asked (in random starting order) concerning changes in the first half of their pregnancy for any of the seven specific beverages listed in Tables 2 and 3. They were also queried specifically concerning the reasons for any changes. They were then queried in an unstructured manner (i.e., without mentioning specific items) concerning cravings or aversions for other foods (or nonfood items) that may have developed at any time in their pregnancy.
Results The data in Table 1 indicate that there were no significant differences between the mothers sampled and the entire group delivering liveborn infants at the two hospitals with regard to race, maternal age, or reported years of schooling (a rough index of socioeconomic status). The mothers queried were not, of course, a representative sample in that mothers of infants with catastrophic outcomes were excluded, but the latter comprised only about 2% of the total of all livebirths at the time in question. Thus there is no reason to believe that inclusion of the latter category in the sample would have markedly changed the distribution of total preferences expressed. (It is possible of course that the small group of mothers in the latter category would have expressed a significantly different set of preferences. This possibility is under investigation in a separate ongoing prospective investigation of mothers in early pregnancy.) The data on changes in consumption in the seven beverages appear in Table 2. In Tables 3 and 4 are listed the reasons for the decreases and increases that were reported. In Tables 5 and 6 appear data on the frequency of cravings and aversions for other food items during pregnancy. Because of the great range in replies concerning specific food items, tabulating these systematically proved difficult. The results of the specific food cravings and aversions, as far as these could be distinguished, appear in TableS. The first footnote of Table 5 explains the scoring system used in this analysis. In Table 6 data on some grouped categories are presented. Discussion Concerning the significant fraction,
seven beverages queried, a at least a quarter, of the
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1355/4655818 by Washington University, Law School Library user on 03 July 2018
TABLE I Comparison of selected characteristics of the study population with mothers of all hivebirths at the two hospitals in the study Study
Mothers of all Iivebirths
population 250
No.
847 %
Race White Black Other Not stated Total
87.2 11.6 1.2
Six
of
100.0
0.8 13.6 28.0 36.0 16.4 4.0 0.8 0 0.4 100.0
0.7 15.5 30.0 35.7 13.4 4.3 0.5 0 0.1 100.2’
1.6 10.0 9.2
0.9 12.4 8.2
in years
Mother’s education schooling completedY 8 8-10 11 12 12 Not stated TotaY a
b
0.4 100.0
or unknown
Maternal age
