How Should I Navigate Ramadan and Pregnancy?

Ramadan is a holy period for Muslims worldwide, where they engage in religious fasting rites for a month. This period has special implications for women in different stages of life, especially for women who are pregnant or have just given birth.

Muslim women around the world who are pregnant or breastfeeding around this time are faced with the dilemma of what to do as the holy month approaches. We will help you understand what is established medically so that you can make the best decision.

It is also common for many pregnant women, even those who are not Muslim, to practice intermittent fasting to avoid weight gain while they are pregnant. This article will help you understand the medical consensus on fasting practices during gestation to help you navigate your decisions.

How Does Fasting Affect Pregnant Women? 

Fasting is the avoidance or restriction of food or water intake for a prolonged period of time. This affects the metabolic and physiologic pathways that occur at the cellular level, affecting the body's whole function. This is because the body will have to mobilize its energy stores as fuel to get you going. 

This process is very important in pregnancy because the fetus also depends on the energy stores of the mother to survive and grow. These nutrients are important during gestation, and nutritional imbalance could lead to birth defects or congenital anomalies.

Fasting does not mean you will be malnourished or suffer from nutritional imbalances; however, it could make you vulnerable. Your well-being and your baby in-utero are the most crucial factors to consider when deciding whether to fast during pregnancy. You should consult your healthcare provider in order to understand whether you are healthy enough to fast.

This is also true for lactating mothers. Expressing milk to feed your baby may be jeopardized if you are dehydrated, which is often seen in people who have fasted for an extended period of time.

Ramadan and Pregnancy

The Islamic religion mandates everyone of sufficient age to fast during the period of Ramadan; however, it creates exceptions for certain people, including pregnant and breastfeeding mothers.

In Islamic law, a woman who has discovered that she is pregnant is exempt from participating in the fasting process if she perceives that the act will be too rigorous for her and may affect her or her child. Pregnant people are allowed to make up for the period missed at a later date when they feel comfortable enough to do it or to participate in something called “fidyah” (a charitable donation).

Despite this, the decision on whether or not to fast is often not straightforward for many pregnant people. Even though Islamic law allows them to defer their fasting days, some women feel awkward or left out of the sacred rites. For many people, their religion makes up a huge part of their identity, and not partaking in certain ritual practices can be emotionally challenging.

Studies have shown that the majority of those who decide to fast claimed that they knew they were exempt from fasting but wanted to try it nonetheless, and many of these women believed that fasting during pregnancy was not detrimental.

Even pregnant Muslim women who do not fast exhibit notable differences in their food consumption and lifestyle during Ramadan compared to other periods of the year. They tend to keep other practices of the period, such as observing Suhoor (the last meal before fasting) and Iftar (the first meal after fasting), eat comparable meals to fasting family members, and adjust their eating patterns in public to show respect for community members, especially if they stay in Islamic countries such as Saudi Arabia, Iran or Indonesia.

One of the most well-known effects of fasting is its impact on serum glucose levels. A prominent study by F. Azizi showed that acute fasting causes a drop in blood glucose levels in pregnant women; however, after 20 hours of fasting, blood glucose levels return to normal. He also reported that glucose levels might be low during the first few days of Ramadan but tend to increase as the month progresses.

Nutritional Needs of Pregnant Women 

As explained earlier, Muslim women can choose whether or not to fast during Ramadan depending on how they feel it could affect them or their baby. To make this decision, it is important to consider all the facts. 

Many studies have failed to reach a conclusion on the effect of fasting on a pregnant woman because there are many superimposing cultural and socio-economic factors. 

According to the NHS, you must eat a balanced and healthy diet while pregnant and ensure your nutrient stores are not deficient. The concept of ‘eating for two’ is a common myth; someone who is pregnant does not need to actually double all their portion sizes. 

According to the CDC, no extra calories are required in addition to the average of 2000 calories per day during the first trimester. Women typically require around 340 extra calories per day during the second trimester and approximately 450 extra per day during the third trimester of pregnancy. It has also been established that eating more than necessary is associated with birthing a baby that is too large or heavy, which could cause perinatal complications for the mother.

All these means that you can fast during Ramadan if you can adequately track and time your intake to fit into the recommended standards.

In addition to nutrients and maintenance of optimal glucose levels, hydration is a major factor when deciding whether or not to fast. Water is important for many of the metabolic processes in the body; therefore, adequate hydration is necessary. Fasting during the month of Ramadan means you cannot consume food or water between dawn and dusk; therefore, you have to ensure that you do not engage in activities that would make you dehydrated, especially if the weather is hot.

Effects of Maternal Fasting on Fetal Health

A recent study showed that fasting for Ramadan had no effect on baby birth weights, and there was no link between fasting and premature delivery. However, the experts say that additional research on fasting and its possible negative health impacts on the fetus still needs to be conducted. 

Another study by Iran J Pediatr has shown that there was no significant difference in the incidence of low birth weight neonates between fasting and non-fasting groups. However, the relative risk of low birth weight was 1.5 times higher in moms who fasted throughout the first trimester compared to non-fasting mothers.

A BMC pregnancy childbirth study on the perinatal effects of Ramadan fasting showed no significant effect on childbirth. The study found that the weight of the placenta was reduced in women who partook in the fasting rites.

Fasting can complicate some common conditions in pregnant women and their babies. Iron deficiency, (anemia) for example, is already more frequent in pregnant women. When a baby does not obtain enough iron, especially during the third trimester, he or she is more likely to develop anemia before age one.

These facts are based on what is found across different studies majorly carried out in Arab countries, thus excluding the cultural and socioeconomic realities of other parts of the world, most of which do not have sufficient sample size; many of the current studies also believe that further cohort studies that will help to observe the long term effect of fasting during pregnancy are needed.

Talking to Your Doctor or Healthcare Provider 

The impact of Ramadan on a pregnant woman is less about the fasting itself and more about the nutrients one consumes in the period they are allowed to eat, in addition to certain external factors such as work and the ability to cope with daily stress. 

Fasting has a unique effect on different people, some of which may be unpredictable and undesirable; therefore, the American College of Obstetricians and Gynecologists advised that it is best to work with your doctor when making any of these decisions.

If you are unsure how fasting will affect you, it is always advisable to give it a trial period even if you have prenatal exposure to fasting because your physiological state is markedly different during gestation. After the trial period, discuss your feelings and experience with your healthcare professional so that they can help you make the appropriate decision.

Diet Tips During Ramadan 

Because energy and nutritional requirements rise during pregnancy and lactation, women require nutritious and safe meals to build up sufficient reserves for pregnancy.

A report by UNICEF showed that a low intake of fruits, vegetables, and dairy (which provides key nutrients for fetal growth) can lead to a child having a lower birth weight or induce more serious complications such as anemia, pre-eclampsia, hemorrhage, and mortality. 

If you’re pregnant and observing Ramadan, it’s important to make sure that the meals you eat in the evening once you break your fast contain all of the nutrients that your baby needs. 

Consuming vitamins and mineral-rich foods, such as iron and calcium, is essential; these can be found in whole-wheat meals, cereals, beans, and unsalted almonds. Slow-release energy sources of food can keep you sustained throughout the day. Make sure to consume lots of protein too; eat meat, beans, and eggs. 

Other tips: 

1. Be careful with portion sizes when you break your fast. Although you’ll likely want to eat a large amount, it’s better to eat normal portion sizes. 
2. Avoid caffeine-containing substances such as coffee and energy drinks that can dehydrate you further, and drink as much water as possible outside of the fasting period. 
3. Do not break your fast by eating sugary foods or foods with high glycemic indices because they may raise your glucose levels too fast; this is especially dangerous for women who are already at risk of gestational diabetes. 

Don't Overexert Yourself If You Choose To Fast 

Fasting may stress an already fatigued body, so it's crucial to take it easy throughout the fasting season, get enough rest, and avoid activity that could cause dehydration. Fasting during the third trimester of pregnancy should be done with caution because this is when you normally require additional calories.

The most important thing is to stay healthy, as you are more likely to cope with fasting if you're a healthy weight and live a generally healthy lifestyle. Your baby needs nutrition from you, and fasting will have less impact if your body has ample energy reserves.

Conclusion

Islamic law provides pregnant women with the option of exemption and deferment if one suspects that they may not cope with Ramadan fasting. 

Even though various researchers have shown that maternal Ramadan fasting does not compromise maternal health and fetal development, especially in cases where one can keep up with their nutritional needs, fasting can still have unpredictable personal effects. Therefore, we recommend that you stay healthy, avoid stress and discuss your feelings with your healthcare provider so that they can help you make the right decision for you.