Does fasting during Ramadan impact pregnancy and birth outcomes?
Ramadan will be be observed by Muslims from March 1. Image: nooh - stock.adobe.com
With Ramadan being observed by Muslims from March 1, the month-long fasting means many people need to make an informed decision about how they can celebrate the holy month while looking after their health.
Pregnant women are exempt from fasting during Ramadan, which they can make up later. However, many pregnant women don't want to miss the opportunity to continue the full or partial month of fasting, during which people abstain from eating and drinking from dawn to dusk.
Some might have questions about whether fasting can impact pregnancy and birth outcomes. So, what does the research tell us? Evidence generated so far is non-conclusive due to a lack of consensus, and evidence-based guidelines are still missing.
One systematic review concluded that the children of women who had fasted throughout Ramadan may experience negative long-term consequences. While children whose mothers were from higher-income environments were more likely to be overweight and might have lifestyle-related disorders, children in low-income environments were more likely to have had their growth stunted and suffer a variety of chronic diseases when they got older.
Ramadan fasting during pregnancy has also been linked to other adverse health outcomes in the long term, although neonatal health is not impacted.
Similarly, another review investigated the effects of fasting during Ramadan on foetal health and identified evidence of low birth weight if pregnant mothers fasted during the third trimester and both the second and the third trimesters. However, the review concludes that data is insufficient to confirm this association.
Conversely, the latest umbrella review paper concludes that pregnancy and birth outcomes are unaffected by fasting during Ramadan. There is no sufficient evidence to support that Ramadan fasting during pregnancy reduces gestational age at birth and birth weight or increases the risk of pre-term birth and low birth weight.
The risk of delivery by caesarean section, gestational diabetes, pre-eclampsia, stillbirth, miscarriage, congenital anomalies, or neonatal deaths has also not been proven by scientific evidence. Another review investigated long-term health outcomes of fasting during Ramadan and found limited evidence to confirm the adverse impacts. Studies that have been done thus far, including various reviews, show methodological limitations in the data produced so far in this area.
Several factors should also be considered when interpreting the findings highlighted in the studies. Fasting patterns differ according to ethnicity and other factors like the mother's health and levels of education, daytime activity levels, and dietary habits outside fasting hours.
To give more conclusive evidence, further prospective research and outcome-specific retrospective studies are necessary.
It is important to honour pregnant Muslim women's wishes if they choose to fast throughout or intermittently during Ramadan, but they should seek advice from a health professional before deciding whether to fast or not.
The British Islamic Medical Association advises pregnant women with uncomplicated pregnancy and well-controlled medical conditions to consider fasting if they intend to do so and can tolerate it, but advises not to fast otherwise.
Health professionals should discuss the conflicting evidence in the scientific literature regarding the issues of Ramadan fasting and pregnancy outcomes so that the trustworthy relationship between a patient and a provider is maintained while exhibiting cultural and religious sensitivity and knowledge.
Professor Dr Muhammad Aziz Rahman is the Head of Public Health and Research Adviser at the Institute of Health and Wellbeing. He is a medical doctor, a public health professional and is also a practising Muslim.
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