Fasting for Ramadan in pregnancy

Is it safe?

There is no clear answer, even though medical studies have looked at the effects of fasting (Cross 1990, CIA/NHS 2007). At the moment, we don't know if fasting is completely safe for pregnant women and their babies (NHS Choices 2008).

If a pregnant woman feels strong and healthy enough to fast, especially during the early part of pregnancy, she may do so. If she doesn't feel well enough to fast, Islamic law gives a pregnant women clear permission not to fast (NHS Choices 2008).

Some studies seem to show little or no effect on newborn babies if their mothers fasted. Others suggest that people may have more health problems later in life if their mothers fasted during pregnancy.

But it is hard to compare different studies done in different ways. Most of the studies we have on fasting in pregnancy are very small, so it's difficult to know for sure. Much may depend on how healthy the mother is before she gets pregnant. Here’s what the research has told us:

• There is no difference between the birth weights and AGPAR scores, which are a way of measuring babies' health at birth, of babies of women who fasted, and the babies of women who did not fast (Arab 2001, Cross 1990, Mirghani 2006).


• Some women who fast during pregnancy may go on to have lower-birth weight babies. However, these results came from a study of women who were more likely to have poor diets or too little food (Sadeghipour 2008).


• Fasting by a pregnant woman does not seem to affect the potential IQ of her baby (Azizi et al 2004, Dikensoy 2008).


• Women do experience changes in the chemical balance of their blood while fasting. But the changes do not appear to be harmful to either the women or their babies, and do not affect the babies' birth weights (Dickensoy 2009).

There have been concerns about whether there is a link between fasting and how well a baby grows in the uterus (womb)and premature labor. Some studies have suggested that more babies are born early during Ramadan, but this depends on which country the mothers live in.

Women whose weight and lifestyle are generally healthy seem to cope better with fasting. Your baby needs nutrients from you. If your body has enough energy stores, then the impact of fasting is likely to be lessened. And it may depend on the many other factors, such as:

• whether Ramadan coincides with hot weather and long days
• what stage you are at in your pregnancy
• your general health before pregnancy
• how long the fast lasts

In places where the fast lasts longer and temperatures are high, dehydration may be more of a concern. Countries nearer the equator -- like the Philippines -- tend to have shorter fasting times. Check the accepted fasting hours for your area.

What do other women do?

Many pregnant Muslim women choose to fast for Ramadan. Some surveys suggest about three quarters of pregnant Muslim women worldwide will fast. Of course, everyone has a different way of observing Ramadan. Most Islamic leaders say you should fast if you are healthy enough to do so.

But they also say that anyone who is unwell or has a condition such as diabetes must not fast. You should not ignore this special permission if you feel that fasting could harm you or your baby.

Only you can judge how healthy you feel and what the right decision is for you. Talk to your family, your doctor and an Islamic sheikh to help you consider your options.

Is there anything I should do before fasting?

Plan ahead to make things easier during Ramadan:

• Talk to your doctor, who can review your physical health and any possible complications, such as gestational diabetes or anemia. There's some evidence which suggests that fasting women may be more prone to diabetes in pregnancy (Mirghani 2006). You may have more check-ups during your fast, to monitor things such as your blood sugar levels, for example.


• If you normally have a lot of caffeinated drinks, such as coffee, tea and cola, try to cut back before starting your fast to avoid withdrawal headaches. Experts say pregnant women shouldn't drink more than 200mg of caffeinated drinks -- or two mugs of coffee -- a day (FSA 2008).


• Talk to your employer about managing your work during Ramadan. In some countries the working hours are reduced during this time. Read more about working and fasting.


• Your doctor, midwife or a dietitian can help you work out your dietary needs.


• Keep a food diary, so you know what you are eating and drinking.


• Start preparing early by doing shopping and errands before the fast.

What's the best way to break the fast?

Be sure to have a variety of healthy food and plenty to drink at Iftar, the pre-dawn meal, and Suhoor, the meal taken at dusk. Choose foods that release energy slowly. Complex carbohydrates, such as whole grains and seeds, and high-fibre foods, such as pulses, vegetables and dried fruits, will help to keep you going and avoid constipation (CIA/NHS 2007).

• Avoid sugary foods that will raise your blood sugar levels quickly. Your blood sugar may also drop quickly, and this may make you feel faint and dizzy.


• Try not to eat high-fat, refined foods. Chose a healthier option, such as potatoes or chickpeas.


• Make sure you get plenty of protein from beans, nuts and well-cooked meat and eggs. Protein is needed to help your baby grow well.


• Drink plenty of fluids overnight. Try to drink two liters of water between dusk and dawn and avoid caffeinated drinks. Caffeine makes you lose more water when you urinate, because it is a diuretic, so you may become dehydrated, especially if the weather is hot.

Are there warning signs I should know about?

Contact your doctor if:

• There is a noticeable change in your baby’s movements. If you feel that your baby is not moving around or kicking much, it is very important to talk to your doctor or midwife right away.


• You are not putting on weight or you are losing weight. Pregnant women are normally weighed during prenatal appointments. You may want to weigh yourself regularly at home when you are fasting.


• You become very thirsty or your urine becomes dark-coloured and strong-smelling. This is a sign of dehydration.


• You notice contraction-like pains. This could be a sign of premature labour and you should tell your doctor straight away.


• You feel dizzy, faint, weak or tired, even after you have had a good rest.


• You develop a headache or other pains, or a fever.


• You become nauseous or start vomiting.

How can I make fasting in pregnancy easier?

• Try to keep calm and avoid stressful situations. Changes in your routine, a lack of food and water and eating and drinking at different times can all cause stress. One study found that pregnant women who fasted had higher levels of the stress hormone, cortisol, in their blood than women who didn't (Dickensoy et al 2009).


• Just take things easy and accept help when it is offered. Although the rest of your family and friends may stay up late, you may need to mark this Ramadan with more quiet, restful time.


• Ask the other women in your family for tips and suggestions about how to cope while you are pregnant.


• Keep cool. You can become dehydrated quickly and that's not good for you or your baby.


• Plan your days so that you can take regular rests.


• Try not to walk long distances and carry anything heavy.


• Cut down on housework and do as little as possible.

I'm still unsure about whether or not to fast. What should I do?

Ask your doctor to give you a general health check-up before you begin. An Islamic sheikh will probably suggest getting medical advice to help you make your decision. Think about doing a trial fast for a day or two. See how you feel and go back to your doctor for a check-up.

Adapted from BabyCentre UK, August 2009