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Pregnant Muslim women may be religiously exempt from fasting during the Islamic month of Ramadan, especially if there is concern for undue hardship or harm to maternal or fetal health. However, several studies demonstrate that most women still choose to fast during pregnancy and avoid discussing fasting with their providers. Results show that strict adherence to fasting in Ramadan during the first trimester was associated with a 270g lower birthweight. However, if Ramadan was in the second or third trimesters, fasting did not affect birthweights. Although fasting could arise at any pregnancy stage, occurrence early in the first trimester seems most likely as the mother may be unaware that she is already pregnant. Ramadan fasting does not affect maternal outcomes during pregnancy. Keywords: Ramadan, Fasting, Preterm delivery, Gestational diabetes mellitus. Ramadan is the ninth month in the lunar calendar. During this month Muslims fast from sunrise to sunset. They are required to abstain from eating, drinking and sexual act during this time period. Participants reported on fasting, dietary composition and sleep schedules while pregnant during Ramadan. Fasting during pregnancy was associated with reduced birthweight, in particular for fasting during the first trimester (-352ˑ92g, 95% CI: -537ˑ38; -168ˑ46). Neither dietary composition nor altered sleep were directly associated with birthweight. Fasting during Ramadan has been mainly associated with signs and symptoms of maternal fatigue and dehydration, with a minimal decrease in weight gain. There is conflicting data regarding the association with gestational diabetes mellitus and insufficient data on maternal hypertension. Participants reported on fasting, dietary composition and sleep schedules while pregnant during Ramadan. Results: Fasting during pregnancy was associated with reduced birthweight, in particular for fasting during the first trimester (-352ˑ92g, 95% CI: -537ˑ38; -168ˑ46). There is little evidence that fasting for the holy month of Ramadan negatively impacts pregnancy or birth outcomes, likely due to limited high-quality primary research. Certain medical conditions necessitate breaking the fast during Ramadan. These include: First Trimester Pregnancy: Fatigue, nausea, and vomiting common during early pregnancy can worsen with fasting, impacting maternal health. Persistent Vomiting: Fasting can exacerbate dehydration, posing risks for both mother and fetus. First Trimester: This is a critical period when the baby’s organs are developing. Many women experience morning sickness, nausea, and fatigue, making fasting more challenging. Second Trimester: Some women find this the most stable phase of pregnancy, where energy levels improve, and nausea subsides. In a systematic review of 16 retrospective longitudinal studies, authors found adverse long-term health and economic outcomes later in adulthood from in utero Ramadan exposure during conception or in the first trimester. 37 Associations were found with higher under-5-year and under-3-month mortality rates; higher incidence of shorter stature 1. Trimester and Fasting. First Trimester: This is a critical period when the baby’s organs are developing. Many women experience morning sickness, nausea, and fatigue, making fasting more challenging. Second Trimester: Some women find this the most stable phase of pregnancy, where energy levels improve, and nausea subsides. An internet based survey regarding physicians perception of maternal fasting found physicians advising against it during second, third trimester, whereas fasting during first trimester was considered controversial.3 Guidelines have also been issued for pregnant women who intend to fast during Ramadan, by various governing bodies.4 However, three studies did suggest a significant effect of Ramadan fasting on AFI, with lower values in the fasting group compared to the non-fasting group during the second or third trimester of pregnancy [20,24,25]. Background and objectives Large shares of pregnant Muslims worldwide observe the Ramadan fast. Previous research showed that Ramadan during pregnancy is associated with adverse offspring health outcomes lasting throughout the life-course. Evidence on effects on birth outcomes is inconclusive, however, and previous research did not consider the role of dietary composition and sleep patterns Continue to monitor your baby’s movements: it is important that you continue to feel baby’s movements every day, especially when taking part in religious fasting. Most people are first aware of their baby moving when they are 18-20 weeks pregnant. If this is your first pregnancy, you may not feel until you are more than 20 weeks pregnant. Complete fasting for the entire Ramadan period was not common, reported by only 14 per cent of women and most fasting occurred during the first and second trimester of pregnancy. The decision to fast during pregnancy was found to be negatively associated with mother’s age and educational level, as both age and education levels increased, the Expand pages Your first trimester. What to expect in your first trimester; Expand pages Your Antenatal Appointments. Meet your healthcare team; What to expect at your first booking appointment; Understanding your maternity record; Understanding your Antenatal check-ups; Your dating scan; Pregnancy risks to be aware of; Morning sickness in pregnancy The only available evidence on Ramadan during pregnancy in Africa is a recent study on Morocco, which documents a fasting rate of 89%, however only reporting on the third pregnancy trimester . Ramadan during pregnancy has been associated with various adverse offspring outcomes, including childhood growth faltering, infant mortality, and chronic Cases of fasting during pregnancy. It should be noted that it may be permissible, obligatory or haram for a pregnant woman not to fast. It is permissible for her not to fast if fasting is too difficult for her, but will not harm her. It is obligatory for her (not to fast) if fasting will cause harm to her or her baby.
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