Ramadan and gestational diabetes: maternal and neonatal outcomes

Turki Abdullah Almogbel,Ted Wu,Lynda Molyneaux,Margaret Mcgill,Anna Jane Harding,Maria Ines Constantino,Abdullah A Alrasheed,Christine Pech,Jencia Wong,Glynis Ross

doi:10.1007/s00592-021-01782-y

Abstract

AimsThe impact of Ramadan exposure to Gestational Diabetes Mellitus (GDM) pregnancies is not known. We therefore aimed to assess the association of Ramadan with maternal and neonatal outcomes among pregnant women with GDM.MethodsRetrospective cohort study of 345 Muslim women with singleton pregnancies who attended a major Sydney teaching hospital during the period 1989–2010, was undertaken. Exposure to Ramadan was stratified by the: (1) total pregnancy days exposed to Ramadan, (2) duration (hours) of daily fasting and (3) trimester of exposure. Maternal and neonatal outcomes were examined by exposure status, and never exposed pregnancies were comparator in all three analyses. Fasting status was not recorded.ResultsWe found no significant effect of Ramadan exposure on mean birthweight, macrosomia and maternal outcomes. However, we found a significant trend for increased neonatal hyperbilirubinemia with increasing Ramadan days exposure and later trimester exposure (ptrend ≤ 0.02 for both), with adjusted OR 3.9 (p=0.03) for those with ≥ 21 days exposure to Ramadan and adjusted OR 4.3 (p=0.04) for third trimester exposure. Conversely longer Ramadan exposure and late trimester exposure were independently associated with a lower prevalence of neonatal hypoglycaemia (adjusted OR 0.4 and 0.3 for ≥ 21 days and third trimester exposure, respectively). Furthermore, neonatal hypoglycaemia decreased for the fasting period of > 15 h group (adjusted OR 0.2, p = 0.01).ConclusionsRamadan exposure is associated with reduced neonatal hypoglycaemia, with no effect on birthweight, implying more favourable glycaemic control. However, the fourfold excess of neonatal hyperbilirubinemia indicates a need for further study of Ramadan and GDM.

Highlights

The Islamic holy month of Ramadan, is one of the five pillars of Islam during which no food or drink is consumed from dawn to sunset for 29–30 days
No significant differences were found in ethnicity, age at pregnancy, pre-gestational BMI, family history of diabetes or parity between the groups
Prevalence of neonatal hypoglycaemia among those exposed to > 10 days of Ramadan was significantly different to the no exposure group (Table 1)

Summary

Introduction

The Islamic holy month of Ramadan, is one of the five pillars of Islam during which no food or drink is consumed from dawn to sunset for 29–30 days. International recommendations (with Islamic religious authority approval) state that women with GDM are deemed to be at high risk and are exempted from fasting during Ramadan [2], studies have shown that ~50% of Muslim women with GDM still opt to fast They do so largely to share the spiritual and social experiences with their family [3, 4]. Previous studies have shown changes in dietary, physical activity, sleep and diurnal patterns among women during Ramadan [8,9,10,11] Taken together, these Ramadan associated lifestyle changes such as fasting, changes in dietary composition irrespective of fasting, changes in physical activity and circadian rhythm could all potentially and cumulatively affect pregnancy outcomes in the context of GDM

Methods

Results

Conclusion