Which gastrointestinal finding at 28 weeks gestation should alert the nurse to a potential concern?

• A. Pica
• B. Pyrosis
• C. Ptyalism
• D. Decreased peristalsis

Answer: (A)

Cravings for nonnutritive substances during pregnancy signal a potential iron deficiency anemia, which becomes more likely as iron needs rise with ongoing fetal growth and placental development around the second and third trimesters. Noting pica at 28 weeks should prompt assessment of iron status (checking hemoglobin, hematocrit, ferritin), review of dietary intake, and consideration of iron supplementation if needed. Pica can also lead to GI complications from ingesting nonfood items and may reflect underlying nutritional deficiency that requires treatment. In contrast, heartburn and excessive saliva are common physiological changes in pregnancy due to hormonal effects on the GI tract, and decreased peristalsis is another typical adaptation; these do not alone indicate a new concern in the same way as pica does.