Metabolic changes in Asian Muslim pregnant mothers observing the Ramadan fast in Britain

Abstract

1. Metabolic changes associated with Ramadan fasting were studied in eleven Asian pregnant mothers. This was compared with a group of control mothers undergoing a normal physiological fast.2. At the end of the Ramadan fast day there was a significant fall in glucose, insulin, lactate and carnitine, and a rise in triglyceride, non-esterified fatty acid and 3-hydroxybutyrate. When compared with the control group, none of the Ramadan mothers had a completely normal set of biochemical values at the end of the fast day.3. Pregnancy outcome in the two groups was comparable. 4. We are wary of the metabolic departures from normal observed in the Ramadan fasting mothers. If asked we advise mothers to take up the dispensation from fasting during pregnancy which is allowed.An important aspect of the Muslim religion is the fast of Rosa during Ramadan. During Ramadan all healthy adults are obliged to fast from sunrise to sunset. The length of the fast therefore depends on the exact time of sunrise and sunset in the country where the person lives. The duration of the fast in temperate climates such as Britain averages about 18 h/d when Ramadan occurs during the spring and summer. This is dependent on the exact time of sunrise and sunset, but is approximately observed between 02.30 and 19.30 hours here. Pregnant women are allowed to postpone their fast until after delivery, but about three quarters of mothers attending this hospital continue to observe it for various reasons (Eaton & Wharton, 1982), for example, convenience when eating as a family, and social pressures. However, they often ask about the possible harmful effects of fasting both to themselves and their babies.Although there is some evidence of metabolic stress in Ramadan (Prentice et al. 1983), the work was carried out in the deprived conditions of the tropics where the prevalence of endemic malnutrition, tropical infection and drought may have compounded the effect of fasting during pregnancy. The better environmental conditions of the Muslim population in Britain provides an opportunity to study the metabolic effect of Ramadan fasting without these complicating factors. Moreover, a previous study in Birmingham of nonpregnant Muslim diabetics (Barber et al. 1979) concluded that fasting was safe. This study was designed to determine the metabolic effects of Ramadan fasting during pregnancy in healthy mothers living in Britain. M E T H 0 D S PatientsAs part of a larger study of glucose metabolism in pregnancy all mothers booking at this hospital in time were invited to attend a clinic at 17 weeks and again at 28 weeks for a more detailed assessment than is usually possible in a routine antenatal clinic. Some of these mothers were selected to take part in this Ramadan study as follows.

The persistent effects of in utero nutrition shocks over the life cycle: Evidence from Ramadan fasting

“…Arab (2004) found that 31 percent of pregnant women in Iran had ketonuria, whereas 61 percent had hypoglycemia before breaking their fast. In the UK and West Africa, Prentice et al (1983) and Malhotra et al (1989) measured unambiguous signs of accelerated starvation in Ramadan among pregnant women who were fasting.…”

“…during pregnancy can have an 'accelerated starvation' effect on the mother, leading to fetal damage (Malhotra et al, 1989;Mirghani et al, 2005;Prentice et al, 1983). Barker's fetal origins hypothesis (Barker, 1995) implies that fetal damage in turn may have long-term impacts on health, cognition and socio-economic outcomes (Almond, 2006;Almond and Currie, 2011;Currie and Vogl, 2012).…”

Maternal Ramadan Fasting and Neonatal Health

“…[1][2][3][4][5][6][7][8][9][10] Accelerated starvation is noticed in pregnant women compared with nonpregnant women after only 12 hours of fasting. 6 After a period of fasting for 13 hours or more, maternal corticotrophin-releasing hormone is elevated compared with those without food for periods less than 13 hours.…”

“…7 There are few studies to discuss Ramadan fasting and its effect on neonatal health. 10,11 Malhotra et al compared metabolic changes in 11 Ramadan-fasted and 11 overnight-fasted pregnant women and none of the Ramadan-fasted mothers had a completely normal set of biochemical values at the end of the fast day. Nevertheless, they did not find any difference between pregnancy outcomes of these two small groups of mothers.…”

“…Nevertheless, they did not find any difference between pregnancy outcomes of these two small groups of mothers. 10 We conducted this study to determine effects of maternal fasting on the neonatal birth weight.…”