Ramadan Observance during Pregnancy in Germany: a Challenge for Prenatal Care

Abstract

Introduction Fasting during Ramadan while pregnant has been shown to have long-term negative effects on the offspringʼs physical and cognitive health. Even though most Muslims do not believe pregnant women are obligated to fast during Ramadan, fasting rates of up to 87% have been reported for pregnant women. No data exists to date about Ramadan adherence and behavior in Germany. Methods The Mainz Study of Ramadan and Pregnancy surveyed pregnant Muslims and new Muslim mothers in Mainz between October 2016 and January 2017 and collected information on Ramadan adherence and behavior. We also collected data on personal characteristics and opinions, to identify determinants of fasting using statistical analysis. Results We found that 43% of pregnant Muslim women fasted at least one day during Ramadan 2016. Women who fasted were significantly younger and less educated. There was no significant difference in terms of country of origin between those women who fasted and those who did not. Only 49% of women who fasted and 38% of women who did not fast discussed their Ramadan behavior with their doctor. Less than 2% of women reported being proactively approached by their doctor. Conclusion To ensure that pregnant Muslim women living in Germany can make their fasting decision based on objective information, it is necessary to raise awareness about Ramadan fasting during pregnancy among medical professionals in Germany.

Ramadan fasting during pregnancy: characteristics and outcomes

“…To our knowledge, this is one of the first studies that examined the characteristics and outcomes of Ramadan fasting in pregnant women over a period of 10 years since most of the studies were conducted over one or few years. 5,8,[10][11][12][13][14][15] The rate of fasting in the current study (84.9%) was similar to the rate of a study conducted in Pakistan (82.8%) and another in Indonesia (80%). 5,13 Other studies showed a lower prevalence of fasting.…”

“…11 Similarly, the prevalence of fasting was 53.9% in a study done in Netherlands and 43% in a German study. 6,15 In the current study, of those who fasted, 65.3% fasted more than 15 days while the rate in Netherlands study was 37.7% and that of Iraq was around 85%. 6,14 The rate of adherence to fasting could be reflected in how the women perceive the religious rule of fasting in pregnancy or how their healthcare providers failed to give them relevant information.…”

“…5 On the contrary, the studies by Leimer et al and Najimudeen concluded that younger women and those with low education level had a higher tendency to fast. 2,15 The Bradford study reported that maternal employment was not significantly associated with fasting whereas women who had higher educational qualifications were less likely to fast as were older mothers compared to younger ones. 11 Safari et al noted in their study that maternal education and employment were significantly different between the fasting and non-fasting women; yet, similar to our study, residency whether urban (Erbil) or suburban, was not significantly associated with fasting.…”

Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh

“…For all these reasons, Muslim women might prefer to fast during Ramadan even when pregnant. Previously reported proportions of pregnant women who fast at least on some days during Ramadan range from around 50% in some high-income countries (Leimer, Pradella, Fruth, Queisser, & van Ewijk, 2018;Savitri et al, 2014) and around 60% in Iran (Ziaee et al, 2010) and Iraq (Safari, Piro, & Ahmad, 2019) to up to 80-90% in the Gambia (Prentice, Prentice, Lamb, Lunn, & Austin, 1983), Indonesia (Savitri et al, 2018), Pakistan (Mubeen, Mansoor, Hussain, & Qadir, 2012) and Yemen (Makki, 2002). Adherence to Ramadan fasting during pregnancy in the present study was comparable to the high levels reported in other low-income countries.…”

“…Following Ramadan in 2018, all pregnant Muslim women and a random third of non-pregnant Muslim women in the FAARM trial were interviewed about their fasting practices and beliefs (n = 852). We adapted a questionnaire from a previous study in Germany (Leimer, Pradella, Fruth, Queisser, & van Ewijk, 2018) to our study setting (available in the supporting information, Table S1).…”