Kaolin Clay Consumption and Pregnancy : Prevalence , Hematological Consequences and Outcome of Labour in the Douala

Objective: To determine the prevalence, haematological repercussions and prognosis of childbirth in the event of consumption of kaolin during pregnancy. Materials and Methods: It was a study over a period of 3 months at the Laquintinie Hospital Douala. It compared two groups of women, one of whom had consumed kaolin during pregnancy (exposed group) and the other had not consumed it (non-exposed group). Results: A total of 342 women were included in our study, 121 (35.4%) of whom had consumed kaolin during pregnancy. Women exposed to this consumption (P < 0.05) after univariate analysis were those of pregnant women from the Far North (OR = 3.37, CI: 1.29 8.79, P = 0.013), single (OR = 1.65, CI = 1.05 2.59, P = 0.029), those with primary education (OR = 2.25, CI = 1.06 4.79, P = 0.035) and those with HIV (OR = 2.75, IC = 1.02-7.43, P = 0.045). Consumption was more frequent in the first trimester of pregnancy (37%) and in the third quarter (34%), at a predominantly weekly rate (47.9%). The most frequently cited reasons were envy (82%), and nausea (45%). This consumption was associated with a risk of premature delivery (RR = 2.26, IC = 1.27 4.05, P = 0.001), yellowish amniotic fluid (RR = 4.66, IC = 1.81 11, P = 0.001), birth weight < 2500 g in newborns (RR = 1.72, IC = 3.36 9.56, P = 0.025), but increased the probability of delivery (RR = 1.94, IC = 0.96 3.90, P = 0.039). For the hematological aspect, the occurrence of anemia (RR = 1.55, IC = 0.97 2.31, P = 0.003) and a decrease in mean hemoglobin concentration (RR = 1.29, IC = 0.83 2.03, P = 0.041) were associated with kaolin in pregnancy. After multiHow to cite this paper: Essome, H., Engbang, J.P., Ndedi, G.P., Valere, M.K., Boten, M., Foumane, P. and Adiogo, D. (2017) Kaolin Clay Consumption and Pregnancy: Prevalence, Hematological Consequences and Outcome of Labour in the Douala. Open Journal of Obstetrics and Gynecology, 7, 1166-1173. https://doi.org/10.4236/ojog.2017.712118 Received: October 9, 2017 Accepted: November 7, 2017 Published: November 10, 2017 Copyright © 2017 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Eating disorders are widespread throughout the world, represented by pathologies such as geophagia, bulimia and anorexia [1].Geophagy is defined as the voluntary feeding of land between 10 -50 g per day [2].It represents the most widespread form of pica; the practice of ingesting non-edible materials [1].It is one of the nutritional disorders frequently occurred in pregnant women [1].The kaolin locally called "kalaba" is the material of predilection of the geophages.It is more or less sweet, white or pinkish clay frequently consumed in Africa, rarely in India and the USA [3].It is believed to have antiparasitic, antidiarrheal, and especially antacid properties [4].Nevertheless, because of its remarkable ion-exchange properties, its consumption would upset the absorption of ions, causing deficiencies, mainly iron responsible for long-term iron deficiency anemia [5].Its consumption is also responsible for other pathologies such as poisoning with heavy metals, pesticides, intestinal occlusions and renal lithiasis [6].Studies in Africa on geophagia and pregnancy show prevalence of 65%, 28% and 50% respectively in Kenya, Tanzania and Nigeria [6] [7].A study carried out in Yaoundé gives a prevalence of consumption of kaolin in pregnancy in the percentage of 32.4% [8].Because of the iron chelating properties of kaolin, its consumption makes it one of the etiologies encountered but little known of iron deficiency anemia [5].Iron deficiency anemia is a condition affecting 20% of pregnant women in developed countries, 51% in developing countries [9].A study carried out in Douala on the prevalence of anemia in pregnancy, evaluated it at 20.5% [10].Nevertheless, the relationship between anemia and soil ingestion is not yet well established.It would be a vicious circle, where ingestion of soil would lead to anemia due to iron deficiency, which would increase the urge to consume soil [5].As part of our contribution to the knowledge of geophagy and its consequences, we proposed to carry out this work, which aimed to investigate the hematological repercussions and the prognosis of childbirth in the case of geophagic practice among pregnant women in the maternity of Douala Laquintinie Hospital.

Methods
It was a study conducted at the Douala Laquintinie Hospital over a period of about 3 months; from 21 February to 31 May 2017.All pregnant women were included, with the exception of those with increased risk factors for bleeding.
Two groups were then constituted, one consuming kaolin and the other not have being consuming.Consumption information, socio-demographic data, medical and obstetric history, labor and blood count were collected.The study materials were an established standardized questionnaire and the result of a biological sampling (NFS) at the time of delivery.The statistical analyses were done by SPSS software version 20.0.The associated factors were investigated using the logistic regression method in univariate and multivariate analysis.The Odds Ratio (OR) and Relative Risk (RR) were used to measure the degree of association.
The significance threshold was set at P < 0.05.
After multivariate analysis using linear logistic regression, the factors independently associated with consumption of kaolin were: being from the extreme North region, single marital status, prematurity and anemia (Table 5).

Discussion
Our study found a 35.4% prevalence of consumption of kaolin in pregnancy (Figure 1).This consumption was spread over the whole pregnancy with a predominance in the first quarter (37%) and the third quarter (34%).It was more frequent during the week and envy was the main reason for this practice at 82% followed by relief of nausea (Table 2).These data are in line with studies conducted in Yaoundé in 2015 and 2016, which stipulate that the consumption of kaolin has a prevalence of 32.4% and 40.5% respectively.The consumption pattern was 49.50% and 55%, respectively [8] [11].
Here, the labor of childbirth and the fate of the newborn were studied.16.37% of the admitted pregnant women had a gestational age of less than 37weeks.Kaolin intake after univariate analysis was found to be a factor that multiplied the risk of premature birth by 2 (RR = 2.26, CI: 1.27 -4.05, P = 0.001).
The color of the amniotic fluid was also influenced by the kaolin intake.An increase in the frequencies of amniotic fluid, yellowish colour and meconium, was observed when consumption of kaolin was observed.This practice had a deleterious effect on the color of the amniotic fluid (RR = 4.66, CI: 1.81 -11.83,P = 0.001); with a four-fold increase in the risk of having a yellowish amniotic fluid at childbirth.
The birth weight of our series varied between 700 -5600 grams and was negatively influenced by consumption.Women Consuming kaolin were 1.72 times more likely to have a newborn baby weighing less than 2500 grams (RR = 1.72,CI: 3.36 -9.56, P = 0.025).
The geophagic practice had the advantage of reducing the risk of an indication of Caesarean section.There was an increase in delivery by low route in the case of kaolin intake (RR = 1.94,IC: 0.96 -3.90, P = 0.039).

Figure 1 .
Figure 1.Prevalence of consumption of kaolin.

Table 1 .
Distribution by kaolin consumption variables.

Table 2 .
Summary of socio-demographic and history variables with a significant association with consumption of kaolin.

Table 3 .
Summary of childbirth labor variables with a significant association with consumption of kaolin.

Table 4 .
Breakdown by blood count.