THE IMPACT OF RAMADAN FASTING ON FOETALGROWTH AND WELL BEING
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University
Background: Fasting is one of the five main practices of Islam. Since maternal nutrition is considered an important modulator of fetal growth, the effect of food and drink deprivation on the fetus is an issue of concern. Fasting is also accompanied with hypoglycaemia which was shown to affect fetal breathing and gross body movements. Furthermore, maternal dehydration causes a decrease in amniotic fluid volume.
Objective: To determine the effect of maternal fasting on fetal intrauterine growth and well being.
Setting: Antenatal outpatient clinic in Kasr Al Aini teaching Hospital, Cairo University.
Patients and Methods: A cohort study including two groups of healthy women with uncomplicated singleton pregnancy >28 weeks of gestation was conducted. Recruitment started one week before Ramadan. The 1st group comprised women who were fasting during Ramadan. The second (control) group consisted of an equal number of non-fasting women matched for age, parity, and gestational age. Ultrasonography was performed on all subjects at baseline and at the end of Ramadan to evaluate the following measurements: estimated fetal body weight, amniotic fluid index, umbilical artery resistance index and modified fetal biophysical profile. The final evaluation also included maternal glucose sampling.
Results: A total of 38 pregnant women were studied. The mean (±SD) number of consecutive fasting days was 21.95±1.51 days. Maternal glucose levels were significantly lower (p < 0.0001), and the time elapse since the last oral intake was significantly longer (p < 0.0001) in the fasting than in the control group. The mean change in estimated fetal body weight, the amniotic fluid index and umbilical artery resistance index were not statistically significant between the two groups. In the fasting group, 6 fetuses (31.6%) had a BPP score of 6/8 compared with 2 fetuses (10.5%) in the control group. All fetuses in both groups with a biophysical score of 6/8 showed no breathing movements. The absence of fetal breathing movements was three times more frequent in the fasting than in the control group. However, this difference did not reach statistical significance. Cases with BPP scores 6/8 had significantly longer time elapse since the last oral intake (p = 0.001) and also significantly lower maternal glucose levels (p = 0.001) than those with BPP 8/8.
Conclusion: Ramadan fasting during the third trimester has no effect on fetal growth, AFI, and umbilical artery resistance index. Fasting, however, does have a significant, effect on maternal serum glucose levels with subsequent affection of fetal breathing movements.