Abstract
Ramadan is one of the five pillars of Islam, during which fasting is obligatory for all healthy individuals. Although pregnant women are exempt from this Islamic law, the majority nevertheless choose to fast. This review aims to identify the effects of Ramadan fasting on the offspring of Muslim mothers, particularly on fetal growth, birth indices, cognitive effects and long-term effects. A systematic literature search was conducted until March 2020 in Web of Science, Pubmed, Cochrane Library, Embase and Google Scholar. Studies were evaluated based on a pre-defined quality score ranging from 0 (low quality) to 10 (high quality), and 43 articles were included. The study quality ranged from 2 to 9 with a mean quality score of 5.4. Only 3 studies had a high quality score (>7), of which one found a lower birth weight among fasting women. Few medium quality studies found a significant negative effect on fetal growth or birth indices. The quality of articles that investigated cognitive and long-term effects was poor. The association between Ramadan fasting and health outcomes of offspring is not supported by strong evidence. To further elucidate the effects of Ramadan fasting, larger prospective and retrospective studies with novel designs are needed.
Highlights
The objective of this paper is to systematically review all literature that reported on Ramadan fasting during pregnancy and health outcomes of the offspring
This systematic review is in line with previous reviews that concluded that Ramadan fasting did not seem to affect the health of healthy, pregnant women nor their offspring [2,11,12]
In addition to the frequency of eating during Ramadan, the quality of the food that women eat during the nighttime deserves attention. In addition to these quantitative studies into the effects of Ramadan fasting, we argue for qualitative research into the communication between pregnant women and their healthcare providers in order to improve the shared decision-making processes concerning fasting during pregnancy
Summary
Ramadan is one of the five pillars of the Islam, along with pilgrimage, prayer, giving to charity and declaration of faith. During this holy month, fasting from dawn until dusk is obligatory for all healthy individuals [1]. The Quran exempts pregnant and lactating women from participating when abstinence from foods and fluids could pose health risks for themselves as well as their unborn babies [2]. Many pregnant and lactating women still engage in Ramadan fasting, due to social, cultural and religious reasons [3]. As the Ramadan follows the Lunar calendar, it always starts eleven or twelve days earlier than the year before and lasts for a totality of approximately 29 to 30 days
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