A patient reports persistent cravings for ice and clay and has low hemoglobin on screening. Which action is most appropriate?

• A. Prescribe a high-dose zinc supplement without further workup because zinc deficiency is the primary cause of pica
• B. Refer for medical evaluation and iron studies because pica (especially pagophagia/soil ingestion) can be associated with iron deficiency anemia and requires investigation and treatment
• C. Reassure her that cravings are normal and no testing or treatment is needed unless she develops severe symptoms
• D. Advise immediate cessation of all prenatal vitamins because they are the likely cause of cravings

Answer: (B)