Fasting During Pregnancy

During Ramadan, adult Muslims abstain from eating and drinking between sunrise and sunset. It is one of the five pillars of Islam and it is thought that over 400 million Muslims worldwide fast each year. Most Islamic scholars agree that pregnant and breastfeeding women are exempt from fasting and that they can choose to observe their fast at a later date. Despite this exemption, many women still choose to fast during Ramadan, preferring to observe the holy month alongside their family. Figures suggest that up to 90% of pregnant Muslim women choose to fast for at least part of the month. So, from a medical perspective, is it OK to fast, and how can you make this deeply spiritual process as stress-free as possible for your unborn child?

Is fasting during pregnancy safe?
A number of scientific studies have explored this question and yet the results are conflicting and there does not seem to be a definitive answer. In general, nutritional excesses and insufficiencies during pregnancy can lead to complications including high or low birth weight and preeclampsia. Furthermore, they can contribute to health problems, such as diabetes and glucose intolerance later in life. However, the precise impact of fasting is inconclusive. One meta-analysis (a combination of data from different studies), found that fasting did not influence birth weight. However, the differing criteria used across the studies meant that no other perinatal outcomes could be measured.

Fasting during pregnancy is only really recommended if you have good overall health and an otherwise complication-free pregnancy. Women with pre-gestational, or gestational diabetes are strongly recommended not to fast as the risk of hyperglycaemia affecting them, or their unborn child is high. Your doctor will also suggest that you avoid fasting if you have high blood pressure, kidney infections, or heart problems

How can I ensure a healthy fast?
Firstly, tell your doctor or midwife that you are planning to fast and take their advice. They may wish to monitor you a little more closely during Ramadan.

Dehydration is a risk, particularly during the long, hot summer months. If you start to feel dizzy, faint, weak and confused you should break your fast with a juice drink and a salty snack, to replace lost sugars, fluids and salts. To avoid this from happening, try not to overexert yourself; stay where it is cool and make sure you take in lots of fluids during suhoor and iftar. When you do eat, ensure that you consume plenty of food that has a high water content, for example, fruits, vegetables, soups and stews.

Continue taking any supplements, such as folic acid and make sure that the food you eat at suhoor and iftar is nutritionally balanced. Consider eating foods with a low glycaemic index at suhoor, as these will release energy slowly throughout the hours that you are fasting. Examples include wholemeal pasta, wholemeal bread, bran-based cereals and beans.

Finally, an option that works for many women is to fast on alternate days, or just at weekends. This reduces the number of days that need to be made up at another time and still enables the woman to feel like she is observing the holy month.

Consider Nabta’s at-home Physio if you consider fasting, have someone to guide you through.

Fasting during Ramadan is a personal decision. Pregnancy can make it more of a physical challenge as the baby has additional nutritional requirements. Make sure the choice you make is well informed and that if you do choose to fast, prior to the start of Ramadan, ensure your overall health is good.

Sources:

• Al-Arouj, M, et al. “Recommendations for Management of Diabetes during Ramadan: Update 2010.” Diabetes Care, vol. 33, no. 8, Aug. 2010, pp. 1895–1902, doi:10.2337/dc10-0896.
• Baynouna Al Ketbi, L M, et al. “Diet Restriction in Ramadan and the Effect of Fasting on Glucose Levels in Pregnancy.” BMC Research Notes, vol. 7, 24 June 2014, p. 392, doi:10.1186/1756-0500-7-392.
• Danielewicz, H, et al. “Diet in Pregnancy-More than Food.” European Journal of Pediatrics, vol. 176, no. 12, Dec. 2017, pp. 1573–1579, doi:10.1007/s00431-017-3026-5.
• Glazier, J D, et al. “The Effect of Ramadan Fasting during Pregnancy on Perinatal Outcomes: a Systematic Review and Meta-Analysis.” BMC Pregnancy and Childbirth, vol. 18, no. 1, 25 Oct. 2018, p. 421, doi:10.1186/s12884-018-2048-y.
• “Ramadan and Pregnancy.” British Nutrition Foundation, www.nutrition.org.uk/healthyliving/nutritionforpregnancy/ramadanpregnancy.html.
• Ziaee, V, et al. “The Effect of Ramadan Fasting on Outcome of Pregnancy.” Iranian Journal of Pediatrics, vol. 20, no. 2, June 2010, pp. 181–186.