Accessible Requires Authentication Published by De Gruyter May 8, 2014

Ramadan fasting and pregnancy: implications for fetal development in summer season

Mehmet Nafi Sakar, Huseyin Gultekin, Bulent Demir, Vuslat Lale Bakir, Deniz Balsak, Erkut Vuruskan, Hicran Acar, Oguz Yucel and Murat Yayla

Abstract

Aims: In the Islamic religion, Ramadan is a month in the year that is passed by fasting. Healthy adult individuals are prohibited to eat, drink, and smoke from sunrise to sunset. In the present study, our aim was to assess the relation of Ramadan fasting with fetal development and maternal-fetal Doppler indices in pregnant women.

Methods: This is a prospective case-control study carried out in the month of Ramadan in 2013 (9 July–7 August). One hundred and six pregnant women at the second and third trimesters of pregnancy were enrolled into the study. The sample size of the fasting group was 83 and the non-fasting group sample size was also 83. Fetal biometric measurements, such as biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal weight, amniotic fluid index, and Doppler indices of both uterine and umbilical arteries were evaluated by gray scala and color Doppler ultrasound at the beginning and end of Ramadan.

Results: At the end of the Ramadan, increase in biparietal diameter, head circumference, and femur length showed a statistically significant difference from initial measurements (P<0.05). When fasting and non-fasting groups were compared separately, an increase in amniotic fluid index was statistically significant in the non-fasting group (P<0.05).

Conclusion: We demonstrated some adverse effects of Ramadan fasting on fetal development. In the Islamic religion, pregnant individuals have the privilege of not fasting; therefore, they should consider postponing fasting to the postpartum period, especially in the summer season. If they are willing to do so, an appropriate nutritional program should be recommended.


Corresponding author: Mehmet Nafi Sakar, MD, Department of Obstetrics and Gynecology, Suleymaniye Maternity Education and Research Hospital, Istanbul, Turkey, Tel.: +90 532 230 87 45, Fax: +90 212 416 98 14, E-mail:

References

[1] Abd-El-Aal DE, Shahin AY, Hamed HO. Effect of short-term maternal fasting in the third trimester on uterine, umbilical, and fetal middle cerebral artery Doppler indices. Int J Gynaecol Obstet. 2009;107:23–5. Search in Google Scholar

[2] Alwasel SH, Abotalib Z, Aljarallah JS, Osmond C, Alkharaz SM, Alhazza IM, et al. Changes in placental size during Ramadan. Placenta. 2010;31:607–10. Search in Google Scholar

[3] Bajaj S, Khan A, Fathima FN, Jaleel MA, Sheikh A, Azad K, et al. South Asian consensus statement on women’s health and Ramadan. Indian J Endocrinol Metab. 2012;16:508–11. Search in Google Scholar

[4] Benson CB, Doubilet PM. Fetal measurements; normal and abnormal fetal growth. In: Rumack CM, Wilson SR, Charboneau JW, Johnson JA, editors. Diagnostic ultrasound. 3rd ed. St. Louis: Mosby; 2004. p. 1499–503. Search in Google Scholar

[5] Cunningham FG, Leveno KJ, Bloom SL, Hauth J, Rouse D, Spong C. Fetal growth disorders. In: Williams Obstetrics. 23rd ed. New York: McGraw Hill Professional; 2010. p. 842–55. Search in Google Scholar

[6] Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. Effect of fasting during Ramadan on fetal development and maternal health. J Obstet Gynaecol Res. 2008;34:494–8. Search in Google Scholar

[7] Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development. Arch Gynecol Obstet. 2009;279:119–23. Search in Google Scholar

[8] El Ati J, Beji C, Danguir J. Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for bodyweight maintenance. Am J Clin Nutr. 1995;62:302–7. Search in Google Scholar

[9] Eller DP, Stramm SL, Newman RB. The effect of maternal intravenous glucose administration on fetal activity. Am J Obstet Gynecol. 1992;167:1071–4. Search in Google Scholar

[10] Ismail Panju Z. Patients who fast in Ramadan need better advice. Br Med J. 2012;345:e4754. Search in Google Scholar

[11] Joosoph J, Abu J, Yu SL. A survey of fasting during pregnancy. Singapore Med J. 2004;45:583–6. Search in Google Scholar

[12] Kamyabi Z, Naderi T. The effect of Ramadan fasting on amniotic fluid volume. Saudi Med J. 2004;25:45–6. Search in Google Scholar

[13] Khoshdel A, Najafi M, Kheiri S, Taheri E, Nasiri J, Yousof H, et al. Impact of maternal Ramadan fasting on growth parameters in exclusively breast-fed infants. Iran J Pediatr. 2007;17:345–72. Search in Google Scholar

[14] Kiziltan G, Karabudak E, Tuncay G, Avsar F, Tuncay P, Mungan O, et al. Dietary intake and nutritional status of Turkish pregnant women during Ramadan. Saudi Med J. 2005;26:1782–7. Search in Google Scholar

[15] Lin CC, Santolaya-Forgas J. Current concepts of fetal growth restriction: part I. Causes, classification, and pathophysiology. Obstet Gynecol. 1998;92:1044–55. Search in Google Scholar

[16] Malhotra A, Scott PH, Scott J, Gee H, Wharton BA. Metabolic changes in Asian Muslim pregnant mothers observing the Ramadan fast in Britain. Br J Nutr. 1989;61:663–72. Search in Google Scholar

[17] Milley JR, Simmons MA. Metabolic requirements for fetal growth. Clin Perinatol. 1979;6:365–76. Search in Google Scholar

[18] Mirghani HM, Salem M, Weerasinghe SD. Effect of maternal fasting on uterine arterial blood flow. J Obstet Gynaecol Res. 2007;33:151–4. Search in Google Scholar

[19] Mirghani HM, Weerasinghe DS, Ezimokhai M, Smith JR. The effect of maternal fasting on the fetal biophysical profile. Int J Gynaecol Obstet. 2003;81:17–21. Search in Google Scholar

[20] Moradi M. The effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy. J Res Med Sci. 2011;16:165–9. Search in Google Scholar

[21] Osol G, Mandala M. Maternal uterine vascular remodeling during pregnancy. Physiology (Bethesda). 2009;24:58–71. Search in Google Scholar

[22] Platt LD, Devore GR, Carlson DE. Growth disturbances: large-for-date and small-for-date fetuses. In: Gahan JP, Goldberg BB, editors. Diagnostic ultrasound; a logical approach. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1393–404. Search in Google Scholar

[23] Rahman M, Rashid M, Basher S, Sultana S, Nomani MZ. Improved serum HDL cholesterol profile among Bangladeshi male students during Ramadan fasting. East Mediterr Health J. 2004;10:131–7. Search in Google Scholar

[24] Saker AH. Fasting in Islam. J Am Diet Assoc. 1975;67:17–21. Search in Google Scholar

[25] Sciscione AC, Hayes EJ. Uterine artery Doppler flow studies in obstetric practice. Am J Obstet Gynecol. 2009;201:121–6. Search in Google Scholar

[26] Shahgheibi S, Ghadery E, Pauladi A, Hasani S, Shahsawari S. Effects of fasting during the third trimester of pregnancy on neonatal growth indices. Ann Alquds Med. 2006;1:58–62. Search in Google Scholar

[27] Wallis MS, Harvey D. Fetal growth, intrauterine growth retardation and small for gestational age babies. In: Robertson NRC, editor. Textbook of neonatology. 2nd ed. London: Churchill Livingstone; 1992. p. 317. Search in Google Scholar

[28] Ziaee V, Kihanidoost Z, Younesian M, Akhavirad MB, Bateni F, Kazemianfar Z, et al. The effect of Ramadan fasting on outcome of pregnancy. Iran J Pediatr. 2010;20:181–6. Search in Google Scholar

[29] Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47:409–14. Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-10-23
Accepted: 2014-4-4
Published Online: 2014-5-8
Published in Print: 2015-5-1

©2015 by De Gruyter