Elucidation of Dietary Intake and Craving Patterns of Pregnant Women at 12-26 Weeks of Gestation: A Cross-Sectional Study in Mid-Western Uganda
DOI:
https://doi.org/10.70851/vfp6z625Keywords:
Craving, pica, dietAbstract
While cravings have historically been documented among pregnant women globally; it remains unclear why women in different contexts crave specific food and non-food items. This cross-sectional survey sought to characterize the dietary practices and craving patterns of resource-constrained pregnant women (N=925) living in a rural context in mid-western Uganda. Women’s health and nutritional status were assessed using anthropometric and biochemical measures plus clinical examinations while, craving patterns and dietary intake were assessed through in-depth structured interviews by trained enumerators.
Cravings were reported by 60.4%, and most women craved for meats. Among those with pica, amylophagy was more prevalent as indicated by craving for raw cassava (31.1%), sundried cassava chips or flour (16%), maize flour (14.1%), and sorghum flour (4.2%). Geophagy was documented among 10.3%; and these craved for soil, molded clay, and wall chippings. Overall, the number of items craved (diversity of cravings) and reports of amylophagy were negatively associated with dietary diversity. However, neither food nor non-food cravings were associated with maternal anemia and fetal size. Further analyses of cravings by food groups revealed that a significantly higher proportion of women in early pregnancy (≤20 weeks of gestation) craved for fruit than those that were greater than 20 weeks of gestation (30.0% vs. 14.8%; X2 = 6.699; p =.010). Additionally, primigravida craved a significantly higher number of non-food items (Mean = 1.84±1.20; 95%CI: 1.53, 2.14; p = 0.015) than women who had experienced other pregnancies (Mean = 1.52±0.83; 95%CI: 1.42, 1.62). Given the low dietary diversity documented in this study, ‘giving in’ to food cravings may help improve pregnant women’s caloric and micronutrient intake, and possibly improve pregnancy outcomes. However, interventions are needed to improve pregnant women’s awareness of the dangers associated with both food and non-food cravings, including amylophagy, geophagy, and other risky dietary and craving practices.
References
Agiresaasi, A., Tumwesigye, N. M., Nabiwemba, E., Kiguli, J., Maina, G. W., & Nassanga, G. (2021). Alcohol use during pregnancy in post-conflict northern Uganda: pregnant women’s experiences and provider perceptions. Substance abuse treatment, prevention, and policy, 16, 1-13. https://doi.org/https://doi.org/10.1186/s13011-021-00418-2
Apprey, C., Addae, H. Y., Boateng, G., Aduku, L. E., & Annan, R. A. (2025). Dietary diversity and nutrient adequacy among women in Bosomtwe District, Ghana. Maternal & child nutrition, 21(1), e13757.
Baum, J. D., Curcio, E. E., & Goodheart, S. E. (2020). Pregnancy Craving and Pica: 60 Years Later. Open Journal of Obstetrics and Gynecology, 10(08), 1079. https://doi.org/https://doi.org/10.4236/ojog.2020.1080101
Bayley, T. M., Dye, L., Jones, S., DeBono, M., & Hill, A. J. (2002). Food cravings and aversions during pregnancy: relationships with nausea and vomiting. Appetite, 38(1), 45-51. https://doi.org/https://doi.org/10.1006/appe.2002.0470
Blau, L. E., Lipsky, L. M., Dempster, K. W., Colman, M. H. E., Siega-Riz, A. M., Faith, M. S., & Nansel, T. R. (2020). Women’s experience and understanding of food cravings in pregnancy: a qualitative study in women receiving prenatal care at the University of North Carolina–chapel hill. Journal of the Academy of Nutrition and Dietetics, 120(5), 815-824. https://doi.org/https://doi.org/10.1016/j.jand.2019.09.020
Bowen, D. J. (1992). Taste and food preference changes across the course of pregnancy. Appetite, 19(3), 233-242. https://doi.org/https://doi.org/10.1016/0195-6663(92)90164-2
Cantor, A., Peña, J., & Himmelgreen, D. (2013). “We never ate like that, not fast food, or junk foods”: Accounts of changing maternal diet in a tourist community in rural Costa Rica. Ecology of Food and Nutrition, 52(6), 479-496. https://doi.org/https://doi.org/10.1080/03670244.2013.824360
Dehury, R. K., Pati, A., & Dehury, P. (2018). Traditional practices and beliefs in post-partum care: Tribal women in Maharashtra. ANTYAJAA: Indian Journal of Women and Social Change, 3(1), 49-63. https://doi.org/https://doi.org/10.1177/2455632718778391
Demissie, T., Muroki, N., & Kogi-Makau, W. (1998). Food aversions and cravings during pregnancy: prevalence and significance for maternal nutrition in Ethiopia. Food and Nutrition Bulletin, 19(1), 20-26. https://doi.org/https://doi.org/10.1177/156482659801900104
Esper, D. H. (2015). Utilization of nutrition‐focused physical assessment in identifying micronutrient deficiencies. Nutrition in Clinical Practice, 30(2), 194-202. https://doi.org/https://doi.org/10.1177/0884533615573054
FAO, & FANTA. (2016). Minimum Dietary Diversity for Women: a guide for measurement. .
Farland, L. V., Rifas-Shiman, S. L., & Gillman, M. W. (2015). Early Pregnancy Cravings, Dietary Intake, and Development of Abnormal Glucose Tolerance. Journal of the Academy of Nutrition and Dietetics, 115. https://doi.org/ https://doi.org/10.1016/j.jand.2015.04.018
Hainutdzinava, N. (2017). Food cravings and aversions during pregnancy: A Current Snapshot. Journal of Pediatrics and Mother Care, 2. https://doi.org/https://doi.org/10.19104/japm.2017.106
Handiso, Y. H. (2015). Prevalence of food aversions, cravings and pica during pregnancy and their association with nutritional status of pregnant women in Dale Woreda, Sidama zone, SNNPRS, Ethiopia. International Journal of Nutrition and Metabolism, 7(3), 1-14. https://doi.org/https://doi.org/10.5897/ijnam2014.0162
HemoCue_AB. HemoCue 301 Operating Manual. In H. AB (Ed.), www.hemocue.com (pp. 36). Angelholm, Sweden.
Hill, A., Cairnduff, V., & McCance, D. (2016). Nutritional and clinical associations of food cravings in pregnancy. Journal of human nutrition and dietetics, 29(3), 281-289. https://doi.org/https://doi.org/10.1111/jhn.12333
Hook, E. B. (1978). Dietary cravings and aversions during pregnancy. The American journal of clinical nutrition, 31(8), 1355-1362.
Ikechukwu, H. U., Ofonime, N. U., Kofoworola, O., & Asukwo, D. E. (2020). Influence of cultural and traditional beliefs on maternal and child health practices in rural and urban communities in Cross River State, Nigeria. Annals of Medical Research and Practice, 1(4), 1. https://doi.org/https://doi.org/10.25259/anmrp_4_2019
Kabahenda, M. K., Amega, R., Okalany, E., Hüsken, S., & Heck, S. (2011). Protein and micronutrient composition of low value fish products commonly marketed in the Lake Victoria region.
Kabahenda, M. K., & Stoecker, B. J. (2024). Associations between maternal dietary intake and nutritional status with fetal growth at 14 to 26 weeks gestation: a cross-sectional study. BMC nutrition, 10(77). https://doi.org/https://doi.org/10.1186/s40795-024-00885-3
Kariuki, L., Lambert, C., Purwestri, R., & Biesalski, H. K. (2016). Trends and consequences of consumption of food and non-food items (pica) by pregnant women in Western Kenya. NFS Journal, 5, 1-4. https://doi.org/https://doi.org/10.1016/j.nfs.2016.09.001
Kimuli, D., Nakaggwa, F., Namuwenge, N., Nsubuga, R. N., Kasule, K., Nyakwezi, S., Odong, J., Isabirye, P., Sevume, S., Mubiru, N., Mwehire, D., Matovu, F., Wandera, B., Amuron, B., & Bukenya, D. (2024). Prevalence and determinants of minimum dietary diversity for women of reproductive age in Uganda. . BMC nutrition, 10(39). https://doi.org/https://doi.org/10.1186/s40795-024-00858-6
Kozlowski, L. T., & Wilkinson, D. A. (1987). Use and misuse of the concept of craving by alcohol, tobacco, and drug researchers. British journal of addiction, 82(1), 31-36. https://doi.org/https://doi.org/10.1111/j.1360-0443.1987.tb01430.x
Madziva, C., & Chinouya, M. J. (2020). Clay Ingestion during pregnancy among Black African Women in a North London Borough: understanding cultural meanings, integrating indigenous and biomedical knowledge systems. Frontiers in Sociology, 5(20). https://doi.org/https://doi.org/10.3389/fsoc.2020.00020
Massey, A., & Hill, A. J. (2012). Dieting and food craving. A descriptive, quasi-prospective study. Appetite, 58(3), 781-785. https://doi.org/https://doi.org/10.1016/j.appet.2012.01.020
Mercer, M. E., & Holder, M. D. (1997). Food cravings, endogenous opioid peptides, and food intake: a review. Appetite, 29(3), 325-352. https://doi.org/https://doi.org/10.1006/appe.1997.0100
Most, J., Dervis, S., Haman, F., Adamo, K. B., & Redman, L. M. (2019). Energy intake requirements in pregnancy. Nutrients, 11(8), 1812. https://doi.org/https://doi.org/10.3390/nu11081812
Muyanja, C., & Namugumya, B. (2009). Traditional processing, microbiological, physiochemical and sensory characteristics of kwete, a Ugandan fermented maize based beverage. African Journal of Food, Agriculture, Nutrition and Development, 9(4).
Myaruhucha, C. (2009). Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania. Tanzania Journal of Health Research, 11(1). https://doi.org/https://doi.org/10.4314/thrb.v11i1.43248
Nakiyemba, O., Obore, S., Musaba, M., Wandabwa, J., & Kiondo, P. (2021). Covariates of pica among pregnant women attending antenatal care at Kawempe Hospital, Kampala, Uganda: A Cross-sectional study. The American Journal of Tropical Medicine and Hygiene, 105(4), 909.
Ndubuisi, N. D., & Chidiebere, A. C. U. (2018). Cyanide in cassava: a review. International Journal of Genomics and Data Mining, 118. https://doi.org/https://doi.org/10.29011/2577-0616.000118
Nordin, S., Broman, D. A., Olofsson, J. K., & Wulff, M. (2004). A longitudinal descriptive study of self-reported abnormal smell and taste perception in pregnant women. Chemical Senses, 29(5), 391-402. https://doi.org/https://doi.org/10.1093/chemse/bjh040
Orloff, N. C., Flammer, A., Hartnett, J., Liquorman, S., Samelson, R., & Hormes, J. M. (2016). Food cravings in pregnancy: Preliminary evidence for a role in excess gestational weight gain. Appetite, 105, 259-265. https://doi.org/https://doi.org/10.1016/j.appet.2016.04.040
Orloff, N. C., & Hormes, J. M. (2014). Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. Frontiers in psychology, 5, 111321. https://doi.org/https://doi.org/10.3389/fpsyg.2014.01076
Otim, O., Juma, T., & Otunnu, O. (2019). Assessing the health risks of consuming ‘sachet’alcohol in Acoli, Uganda. PloS one, 14(2), e0212938.
Papageorghiou, A. T., Kennedy, S. H., Salomon, L. J., Altman, D. G., Ohuma, E. O., Stones, W., Gravett, M. G., Barros, F. C., Victora, C., & Purwar, M. (2018). The INTERGROWTH-21st fetal growth standards: toward the global integration of pregnancy and pediatric care. American journal of obstetrics and gynecology, 218(2), S630-S640.
Papageorghiou, A. T., Ohuma, E. O., Gravett, M. G., Hirst, J., Da Silveira, M. F., Lambert, A., Carvalho, M., Jaffer, Y. A., Altman, D. G., & Noble, J. A. (2016). International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries. bmj, 355.
Pay, A., Frøen, J., Staff, A., Jacobsson, B., & Gjessing, H. (2016). Prediction of small‐for‐gestational‐age status by symphysis–fundus height: a registry‐based population cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 123(7), 1167-1173. https://doi.org/https://doi.org/10.1111/1471-0528.13727
Pelchat, M. L., Johnson, A., Chan, R., Valdez, J., & Ragland, J. D. (2004). Images of desire: food-craving activation during fMRI. Neuroimage, 23(4), 1486-1493. https://doi.org/https://doi.org/10.1016/j.neuroimage.2004.08.023
Placek, C. D., & Hagen, E. H. (2015). Fetal protection: the roles of social learning and innate food aversions in South India. Human Nature, 26, 255-276. https://doi.org/https://doi.org/10.1007/s12110-015-9239-2
Placek, C. D., Madhivanan, P., & Hagen, E. H. (2017). Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: Separate systems to protect the fetus? Evolution and Human Behavior, 38(6), 714-728. https://doi.org/https://doi.org/10.1016/j.evolhumbehav.2017.08.001
Puwanant, M., Boonrusmee, S., Jaruratanasirikul, S., Chimrung, K., & Sriplung, H. (2022). Dietary diversity and micronutrient adequacy among women of reproductive age: a cross-sectional study in Southern Thailand. BMC nutrition, 8(1), 127. https://doi.org/10.1186/s40795-022-00619-3
Rainville, A. (1998). Food Cravings and Dislikes of Pregnant Women from Four WIC Clinics in Texas. Journal of the American Dietetic Association, 98(9), A61. https://doi.org/https://doi.org/10.1016/s0002-8223(98)00519-7
Rodríguez-Martín, B. C., & Meule, A. (2015). Food craving: new contributions on its assessment, moderators, and consequences. Frontiers in psychology, 6, 21. https://doi.org/https://doi.org/10.3389/fpsyg.2015.00021
Soma-Pillay, P., Nelson-Piercy, C., Tolppanen, H., & Mebazaa, A. (2016). Physiological changes in pregnancy: review articles. Cardiovascular journal of Africa, 27(2), 89-94. https://doi.org/https://doi.org/10.5830/CVJA-2016-021
Steinmetz, A. R., Abrams, E. T., & Young, S. L. (2012). Patterns of nausea, vomiting, aversions, and cravings during pregnancy on Pemba Island, Zanzibar, Tanzania. Ecology of Food and Nutrition, 51(5), 418-430. https://doi.org/https://doi.org/10.1080/03670244.2012.696011
Swindale, A., & Bilinsky, P. (2006). Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. The Journal of nutrition, 136(5), 1449S-1452S. https://doi.org/https://doi.org/10.1093/jn/136.5.1449s
Taetzsch, A., Roberts, S. B., Gilhooly, C. H., Lichtenstein, A. H., Krauss, A. J., Bukhari, A., Martin, E., Hatch-McChesney, A., & Das, S. K. (2020). Food cravings: Associations with dietary intake and metabolic health. Appetite, 152, 104711. https://doi.org/https://doi.org/10.1016/j.appet.2020.104711
UBOS, & ICF. (2011). Uganda demographic and health survey 2011. Retrieved from https://extranet.who.int/fctcapps/sites/default/files/2023-04/uganda_annex1_dhs_2011.pdf
UBOS, & ICF. (2018). Uganda demographic and health survey 2016.
Weigel, M. M., Coe, K., Castro, N. P., Caiza, M. E., Tello, N., & Reyes, M. (2011). Food aversions and cravings during early pregnancy: association with nausea and vomiting. Ecology of Food and Nutrition, 50(3), 197-214. https://doi.org/https://doi.org/10.1080/03670244.2011.568906
WHO. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. In WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/publications/i/item/9789241549912
WHO. (2024). Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. World Health Organization.
Yeneabat, T., Adugna, H., Asmamaw, T., Wubetu, M., Admas, M., Hailu, G., Bedaso, A., & Amare, T. (2019). Maternal dietary diversity and micronutrient adequacy during pregnancy and related factors in East Gojjam Zone, Northwest Ethiopia, 2016. BMC nutrition, 19(173). https://doi.org/https://doi.org/10.1186/s12884-019-2299-2
Downloads
Published
Versions
- 2025-11-09 (2)
- 2025-11-06 (1)
License
Copyright (c) 2025 Dr. Margaret Kiiza Kabahenda (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
