Pica is an eating disorder in which non-nutritional objects are frequently eaten, and may have serious side effects for both the mother and neonate. The aim of this study was to determine the pica and its association with biochemical profiles of pregnant women and its relation to pregnancy outcome. A prospective cohort study was conducted in five health care centers in Zahedan City, Iran, in 2011-2012. Samples of pregnant women (n = 200) in the age groups 18 - 40 years were selected for this study and interviewed using a questionnaire. Maternal biochemical profiles (hemoglobin and ferritin) during pregnancy, mean gestational age and pregnancy outcome namely height, weight, and head circumferences of neonates were compared to pregnant women who reported pica (pica group) and women who did not (without pica group). The results showed pica prevalence categorized by substance as follows: clay (23.3%), ice (53.7%), ice and freezer frost (11.5%) and other substances (11.5%). Women in pica group had lower hemoglobin levels during the three trimesters of pregnancy than without pica group. Head circumferences of neonates in pica groups were significantly lower than those of without pica groups (31.0 ± 0.6 vs. 34.0 ± 0.2 respectively). There were no differences in mean birth weight, length, gestational age of infants born to pregnant women from the pica group and without pica group. The findings suggest that the pica practices during pregnancy are associated with lower maternal hemoglobin during the pregnancy periods, and also significantly lower head circumferences of neonates. Dietitians should ask pregnant women with anemia about pica and should counsel pregnant women who report pica.