The existing literature mainly focuses on
the impact of the fasting mother during pregnancy on nutritional level, health
outcomes and weight change in a child.
Although fasting during Ramadan is a universal phenomenon for Muslims
all over the world, however these studies represent mixed results due to
different cultural, geographical conditions and income levels in different
countries. Some of the studies from existing literature have been reviewed.
A number of studies have found the adverse
effects of maternal fasting on fetal health, fetal breathing and fetal heart
Almond and Mozmudar, 2011 used holy month
of Ramadan as a natural experiment to analyses the fetal health during fasting.
In case of Michigan sample 1989-2006 for Arab Muslim parents, they found lower
birth weights and reduction of male offspring if Ramadan overlapped with first
gestation month. A strong positive association was found between utero exposure
to Ramadan and disability at an adult age, especially mental or learning
disabilities in Uganda Census 2002 and Iraq Census 1997.In addition, they found
positive effects wealth, earnings and composition of adult age. No evidence was
found for negative selection in conception during Ramadan.
In another study of Almond, Chay, and Lee,
Attitude towards the male offspring is
depend on the sensitivity of maternal health Trivers and Willard, 1973.
It can be safely concluded in the light of the above
studies that fasting during early stages of pregnancy has a negative effect on
fetal health. A study to determine relationship between
fasting during pregnancy and birth weight relationship
was conducted in Iran for a sample of forty-three hundred women by The sample
was divided into four groups that is fasting, non-fasting group. They did not
find any kind of significant impact on birth weight of infant in fixed no of
days fasting and non-fasting group, other than second trimester with
insignificant results. They also said to do fast in first trimester was more in
comparison of other trimester. Arab and Nasrollahi, 2001.
To find the long-term effect of fasting during
pregnancy there is one study conducted in between 191 children under age 4 to
13 years from 15 Islamic primary schools of Iraq, consider 98 children in a
treatment group whose mothers they did fast and other are control group, they did
not do any fas0 t. They didn’t found any kind of significant differences in
between of age, sex and IQ scores of two groups Azizi et al. 2004.
Cohen and Kim, 2009 used aggregated data from the
Behavioral Risk Factor Surveillance System (BRFSS) with special module
regarding weight loss. To reduce weight during pregnancy is a high risk for
both mother and baby, evidence found that tendency to reduce weight is higher
in the age group of 35-44 years, most probably the pregnancy is unwanted and
they are unaware about her conception.
Some studies have also come up with the results where
Ramadan fasting has been found to be associated with the increase in cortisol
level in healthy pregnant women with pregnancy duration of around 20 weeks, most
probably the reason is rich carbohydrate food people like to consumed during
fasting Dikensoy et al. 2009. The cristols a stress
hormone frequently raised as a potential mechanism through which prenatal
experiences may “program” adult health Kapoor et al., 2006.
Franko et al, 2009 said about 20 million of the children
were born as low birth weight in developing countries as a main reason of child
mortality or many other infective illness. Oxygen and glucose supply during
early pregnancy period is so essential for embryonic development and “poor
malnutrition at this stage produces offspring’s with higher blood pressure”Gluckman
and Hanson, 2005.
In another study 284 of neonates of the mother with a
history of fasting during Ramadan were compared with 255 neonates of the
mothers who did not faced Ramadan during pregnancy. The univariate analysis
showed that weights of the children born to the mothers with fasting history
were more than the weights of the children born to the non-fasting mothers with
significant probabilities. Controlling for BMI showed that neonates of fasting
mothers were 71 gram higher than those of non-fasting mothers, however these
results were not significant. The study concluded no effect of Ramadan on child
birth weights Kavehmanesh and Abolghasmi, 2004.
Kraemer, 2000 found very surprisingly
finding regarding fetal and neonatal mortality higher among girls in
Chinese-American also with poor health condition after birth. A Prospective
study was conducted in Yemen, Sana’s city on effect of Ramadan fasting on
pregnant diabetic mothers. 90.3% pregnant diabetic women are likely to be fast
more than 20 days and there is no relationship in between Lower birth weight.
Malhotra et al. (1989) studied the metabolic changes
during Ramadan for a sample of fasting eleven pregnant women of Asia. The sample
was compared with the control group of normal mothers observing fast. There was
a significant fall in the glucose, insulin, lactate and carnitine and a rise in, non-esterified fatty acid, triglyceride
and 3-hydroxybutyrate none of the fasting mothers from control group had a
normal biochemical reading at the end of fasting. The pregnancy outcomes in the
two groups were comparable.
In a cohort study of 70 Jordanian
students on different anthropometric parameters and they found Ramadan has a
significantly lower impact in comparison of pre-Ramadan, another important
results is that after 2 weeks of Ramadan body weight and other parameter have a
tendency to retrieve pre-Ramadan status but still lower significant impact
before pre-Ramadan. Ramadan fasting on serum lipid levels may be closely
related with nutritional diet and biochemical response to starvation Mansi, 2007.
Sex ratio at birth and maternal
nutritional status of 740 Britain females before conception, after 14 week
gestation length and 28 weeks gestation length they found no significant impact
in case of male offspring with differences of nutritional intake but a profound
significant impact of male offspring if nutritional level is higher before
conception. Dietary intake especially cereals played an important role on
infant sex Mathews et al, 2008.
Restricted maternal nutrition is
associated with higher risk of neonatal admission in SCBU Mirghani and Hamud,
2006. In a study conducted in UAE by Mirghani et. al. (2004) of health
women observing Ramadan at a thirty weeks of gestation period with a control
group of non-fasting women to determine the fetal biophysical profile found
significant differences among the fetal bio profile of fasting and non-fasting
mother. The study concluded that fetal breathing movement are reduced when
mother is fasting on the same day.
During pregnancy period highly recommended by doctors
“Eat small to moderate-sized meals at regular intervals, and eat nutritious
snacks”. This is the best way to get proper nutrition requirement for you and
your baby. Institute of medicine, 1992: 45.
The health effects of fasting on pregnant
women may further be gauged by a comparative study conducted by Metzger et al. 1982 documented a set of divergent
metabolic changes on conceived mother who skipped breakfast especially on
second trimester. They studied the impact of Ramadan fasting among twenty-seven non pregnant and twenty-one pregnant women
with the same characteristics, of “circulating fuels and glucose
regulatory hormones. The level change
drastically when overnight fasting was extended to the following afternoon in
pregnant women”. Further the level of plasma glucose and alanine was lower
among pregnant women after twelve hours of fasting.
These kinds of changes are termed as ‘accelerated starvation’ which are prone
to impact the cognitive functions negatively Rizzo et al., 1991.
A study in Tehran was conducted for women facing one
of the trimester during Ramadan dividing into four groups, non-fasting, 1-10
days fasting, 11-20 days, 21-30 days fasting. No significant differences were
observed between BMI at the
beginning of pregnancy, mother’s age, number of pregnancies, and a history of
abortion in different groups. Also no significant differences between pregnancy
outcome parameters and fasting at different trimesters
Kiziltan et. Al (2005)
analyzed the nutritional status of the pregnant fasting mothers during Ramadan
and compared them with a control group of non-fasting mothers. The weight gain
and energy intake was lower in the fasting pregnant mothers compared to the
control group during third trimester. The percentage of protein for first and
second trimester and carbohydrates for all trimester was higher in fasting
mothers. They observed a slight increase
in the fasting blood glucose, serum total cholesterol high-density
lipoprotein-cholesterol and triglycerides. The study concluded that there were
no adverse nutritional effects of Ramadan on fasting mothers. Bilson et. al
(2016) investigated the sample of 187 pregnant women in a n antenatal
care centre in jakarta. They found that the adherence to fasting was reduced by
4% with every week increase in gestation period, and increased by 10% for every
one unit increase of women’s pre pregnancy body mass index (BMI). The regression
analysis for fasting women was found to be negatively associated with women’s
gestational age, fear of possible adverse effects of fasting on their own or
the fetal health, and with opposition from husbands. In conclusion, earlier
gestational age during Ramadan, husband’s opinion and possibly higher pre
pregnancy BMI, and influence women’s adherence to Ramadan fasting during
In a natural experiment of Chinese famine 1959-1961by
using the 1% sample of census 2000 they found if the fetal exposure to acute
malnutrition had many demographic and exogenous demographic characteristics. It
is also reduces the birth of male offspring Almond et al, 2007.
Asking et al, 1999 investigate the Swedish
population-based study to examine all women between 1987-95, who faced
hyperemesis gravidarum during pregnancy and compared their sex ratio. Results
shows that those women’s they faced hyperemesis gravidarum during early
pregnancy have a positive association of female offspring. No evidence was
found during second and third trimester.
Shahgheibi at al. 2005 mainly focused on third
trimester of pregnancy with different anthropometric measurement of 179 newborn
babies. 33 grams low birth weight, 0.2-centimeter lower birth length was found
with insignificant results.