Ramadan Fasting and Maternal Perspectives in Healthy Pregnant Women: Systematic Review

Background: Practicing fasting during Ramadan by pregnant women might be risky. Controversies still exist about the nature and the magnitude of metabolic changes in healthy pregnant women who practice fasting.
Objectives: To systematically review literature pertaining to the practice of Ramadan fasting and the effect of fasting on maternal health.
Methods: Relevant literature was obtained through searches of PubMed, and Cochran's. Incidence and duration of fasting, reasons for non-fasting, dietary changes, physical activity, weight changes, symptoms with fasting, and metabolic parameters for healthy pregnant women who fasted during Ramadan were extracted. Synthesis of data was performed when appropriate.
Results: Out of 56 English-language studies, 21 addressed maternal perspectives, 85.57% women experienced fasting during pregnancy, 76.26% fasted the whole month or ≥20 days, 80.9% perceived fasting as obligatory, 63.1% perceived no harm in fasting during pregnancy, and 17.6% broke their fast because of harm. The reasons for non- fasting included pregnancy (25%), coexisting medical problems (20.6%), symptoms (16.2%), daily commitments (16.2%), personal, family reasons (13.2%), and belief that fasting is not compulsory (8.8%). Common symptoms were hunger or thirst (16.82%), nausea or vomiting (7.47%), giddiness (6.66%), fatigue (17.01%), and fever or headache (2.72%). Accelerated starvation was reported in many studies; whereas hyperglycemia was reported in only 2 studies. Negative impact of fasting on lipids and hormones was reported in a few studies.
Conclusion: There are large gaps in knowledge, and more large interventional clinical trials are needed. In the light of available research, the majority of pregnant women showed a strong sense of religious obligation and chose to fast, even though some of them did not fully recognize their right to be exempted. There is still no definite evidence that accelerated starvation due to Ramadan fasting during an uncomplicated pregnancy can adversely affect maternal health.