All Muslims, exception pregnant women, are expected to fast during the holy month of Ramadan. The survey don by Joosop, Abu and Yu explored how pregnant women in Singapore practice fasting in relation to socio-economic and parity factors. The study also examined factors that affect expectant women’s’ choice to fast and how they achieved this goal. It also assessed their beliefs, perceptions and knowledge on fasting during Ramadan. This study involved all pregnant women who received antenatal care at Singapore General Hospital during the fasting period (November 17th– December 16th, 2001). The researchers mailed questionnaires to all participants in March 2002 (Joosoph, Abu & Yu, 2004, p.583).
According to Malihe Arab and Shahla Nasrollahi, all Muslim expectant women crave to fast during Ramadan. However, they are concerned about the wellbeing of their unborn babies (2001, p.91). Since obstetricians lack information about this matter, a cross-sectional study was carried out to establish the relationship between fasting and birth weight of babies delivered in Hamadan region. The study used 4, 343 eligible expectant women who were split into four groups, according to the number of days fasted. The study concluded that the birth weights of delivered infants were not influenced by Ramadan fasting during pregnancy (Arab & Nasrollahi, 2001, p.91). Ziaee et al note that pregnancy is a physiology condition that can be complicate when an expectant woman decides to fast during Ramadan (2010, p.181). Ziaee and others conducted a study in 2004 on one of the hospitals in Tehran to assess the impact of fasting among pregnant women on pregnancy outcome. The study used 189 expectant women who fasted during the first trimester of Ramadan. They were split into three groups: non-fasting; fasting (1-10 days); fasting (11-20 days); and fasting (21-30 days). The study concluded that Ramadan fasting had no adverse effects on unborn infants among healthy expectant women with apt nutritional diet. However, pregnant women who fasted during the first trimester were 1.5 times likely to deliver underweight babies (Ziaee et al., 2010, p. 181). In another cross-sectional study done at Kerman Prenatal Clinic in Iran to assess the impact of fasting during Ramadan on the volume of amniotic fluid, participants were split into two groups (fasting=28 and non-fasting=25) to examine amniotic fluid index (AFI) during the 2001 Ramadan period. The study concluded that fasting did not affect AFI and amniotic fluid volume (Kamyabi & Naderi, 2004, p. 45).
Another case-control study was done during Ramadan to assess fundal height increase among pregnant women who fasted and those who did not. The study used 101 expectant women at Kerman private prenatal clinics in Tehran. The study, done in 2001, used expectant women based on several factors such as socio-economic status, age and prior delivery experiences. The study concluded that, among healthy expectant women, fasting did not affect intrauterine growth of unborn babies (Naderi & Kamyabi, 2004, p810). Previous studies have shown that fasting does not adversely affect healthy pregnant women. Robinson and Raisler conducted a study to asses the impact of Ramadan fasting among expectant women living in the US. A sample of 32 participants living in Muslim communities in Michigan was enlisted in the study. The study found that over 90% of the participant value fasting during Ramadan and that the practice enhanced their physical, psychological and social wellbeing (Robinson & Raisler, 2005, p. 99).
However, other studies have shown that fasting has a negative impact on the health of unborn baby. Almond and Mazunder (2008) used the Michigan natality data to demonstrate that pregnant women who fasted were likely to experience shortened gestation period and deliver underweight babies (p.1). Also, Reyn van Ewijk used a cross-sectional data from Indonesia to demonstrate the long-term effects of Ramadan fasting on delivered babies. His study revealed that individuals who were exposed to Ramadan fasting before their birth are susceptible to illness than others (van Ewijk, 2011, p. 1). Maryam Moradi also carried out a study to assess the influence of Ramadan fasting on fetal growth. Her study recruited 52 pregnant women who were classified into two groups (fasting=25; non-fasting 27). She used growth parameters such as femora length (FL), bi-parietal diameter and abdominal circumference (AC) to approximate fetal growth. The outcome of the study revealed that fasting did not affect fetal growth (Moradi, 2011, p. 165). Also, Shobokshia and Elnouria used blood samples from 55 expectant women to assess the impact of Ramadan fasting on endocrine control of glucose homeostasis. The study showed that fasting did not influence postprandial levels of insulin, glucose and glucagons in pregnant women who fasted during Ramadan (Shaarawy, Shobokshia & El-Nouria, 1996, p.453).
It was in the process of undertaking this literature review that it became apparent that there are significant gaps in the knowledge base for the effects of Ramadan fasting in pregnant women. The literature review presented above dwelled only on the short-term effect of fasting on fetal health. Future studies need to explore the long-term outcomes of fasting on the wellbeing being of unborn babies to enable medical doctors provide informed advice to expectant women who decide to fast during Ramadan.
References
Almond, D and Mazumder, B. (2008) The Effects of Maternal Fasting During Ramadan on Birth and Adult Outcomes. Chicago, Federal Reserve Bank of Chicago.
Arab, M and Nasrollahi, S. (2001) Interrelation of Ramadan Fasting and Birth Weight. Medical Journal of Islamic Academy of Sciences, 14, 91-95.
Joosoph, J., Abu, J and Yu, SL. (2004) A Survey of fasting during pregnancy. Singapore Medical Journal, 45, 583-586.
Kamyabi, Z., and Naderi, T. (2004) The effect of Ramadan fasting on amniotic volume. Saudi Med Journal, 25, 45-46.
Moradi, M. (2011) The Effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy. JRMS, 16, 165-169.
Naderi, T and Kamyabi, Z. (2004) Determination of fundal height increase in fasting and non-fasting pregnant women during Ramadan. Saudi Med Journal, 25, 809- 812.
Robinson, T and Raisler, J. (2005) Ramadan Fasting Among Pregnant Muslim Women in the United States. Ethnicity and Disease, 15, 99-103.
Shaarawy, M., Shobokshia, A and El-Nouria, A. (1996) The Fast of Ramadan, its Effects on Endocrine Control of Glucose Homeostasis. Arab J Lab Med, 22, 453 465.
Van Ewijk, R. (2011) Long-term health effects on the next generation of Ramadan fasting during pregnancy. Amsterdam, University of Amsterdam.
Ziaee, Kihanidoost et al. (2010) The Effect of Ramadan Fasting on Outcome of Pregnancy. Iranian Journal of Pediatrics, 20, 181-186.