The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis

Sabiha Hussain,Nick Ashton,Joanne Whitcombe,Jocelyn D Glazier,Alexander E P Heazell,Dexter J L Hayes,Stephen W D’Souza

doi:10.1186/s12884-018-2048-y

Abstract

BackgroundAlthough exempt, many pregnant Muslim women partake in the daily fast during daylight hours during the month of Ramadan. In other contexts an impoverished diet during pregnancy impacts on birth weight. The aim of this systematic review was to determine whether Ramadan fasting by pregnant women affects perinatal outcomes. Primary outcomes investigated were perinatal mortality, preterm birth and small for gestational age (SGA) infants. Secondary outcomes investigated were stillbirth, neonatal death, maternal death, hypertensive disorders of pregnancy, gestational diabetes, congenital abnormalities, serious neonatal morbidity, birth weight, preterm birth and placental weight.MethodsSystematic review and meta-analysis of observational studies and randomised controlled trials was conducted in EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar, the Health Management Information Consortium and Applied Social Sciences Index and s. Studies from any year were eligible. Studies reporting predefined perinatal outcomes in pregnancies exposed to Ramadan fasting were included. Cohort studies with no comparator group or that considered fasting outside pregnancy were excluded, as were studies assuming fasting practice based solely upon family name. Quality of included studies was assessed using the ROBINS-I tool for assessing risk of bias in non-randomised studies. Analyses were performed in STATA.ResultsFrom 375 records, 22 studies of 31,374 pregnancies were included, of which 18,920 pregnancies were exposed to Ramadan fasting. Birth weight was reported in 21 studies and was not affected by maternal fasting (standardised mean difference [SMD] 0.03, 95% CI 0.00 to 0.05). Placental weight was significantly lower in fasting mothers (SMD -0.94, 95% CI -0.97 to -0.90), although this observation was dominated by a single large study. No data were presented for perinatal mortality. Ramadan fasting had no effect on preterm delivery (odds ratio 0.99, 95% CI 0.72 to 1.37) based on 5600 pregnancies (1193 exposed to Ramadan fasting).ConclusionsRamadan fasting does not adversely affect birth weight although there is insufficient evidence regarding potential effects on other perinatal outcomes. Further studies are needed to accurately determine whether Ramadan fasting is associated with adverse maternal or neonatal outcome.

Highlights

Exempt, many pregnant Muslim women partake in the daily fast during daylight hours during the month of Ramadan
Placental weight was significantly lower in fasting mothers (SMD -0.94, 95% Confidence interval (CI) -0.97 to − 0.90) (Fig. 5)
Subgroup analysis for risk of bias was not conducted. This meta-analysis did not find any significant associations between Ramadan fasting and pregnancy outcome

Summary

Introduction

Many pregnant Muslim women partake in the daily fast during daylight hours during the month of Ramadan. The aim of this systematic review was to determine whether Ramadan fasting by pregnant women affects perinatal outcomes. During the month of Ramadan, healthy adult Muslims abstain from eating and drinking from sunrise until sunset. This represents a form of intermittent fasting where both the quantity and quality of food eaten are altered [1]. Pregnant Muslim women are exempt from fasting, evidence suggests that up to 90% partake in Ramadan fasting for at least part of the month [2, 3], being keen to share the cultural experience with their families. Preterm delivery and reduced birth weight are more prevalent in women who eat less frequently while pregnant [8], suggesting that pregnant women who fast during Ramadan may be more likely to give birth to premature or underweight babies

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Discussion

Conclusion