Study reveals effects of Ramadhan fasting on pregnancy

Shafaqna English– The London School of Economics and Political Science has published the paper “Long-Term Health Effects on the Next Generation of Ramadhan Fasting During Pregnancy” written by Reyn van Ewijk in 2009.

According to Shafaqna, this paper shows that people who were exposed to Ramadhan fasting during their mother’s pregnancy have a poorer general health and are sick more often than people who were not exposed.

Each year, many pregnant women fast from dawn to sunset during the Islamic holy Month of Ramadhan. Medical theory suggests that this may have negative long-term health effects on their children. This effect is particularly marked among older people, who, when exposed, report health problems that are suggestive of coronary heart problems and type 2 diabetes.

The exposed are a bit smaller in body size and weigh less. Among Muslims born during Ramadhan and in the months after it, the share of males is lower which is most probably to be caused by death before birth. The findings are mentioned below:

1. Mothers’ behavior and consumption during pregnancy have long-term effects on their children’s health, as is evidenced by research on the effects of smoking and of the consumption of e.g. alcohol and coffee during pregnancy. Medical studies show that fasting during pregnancy in the form of skipping breakfast and other meals may be another aspect of mother’s consumption and behavior that may have a negative effect on the health of their children, which may continue into adulthood.
2. Pregnant women are allowed to skip fasting if they are worried that fasting may harm their own health or the health of their foetus.
3. Long-term effects are principally expected to arise because a shortage in nutrition impede foetal growth and causes damage to the foetal body, while simultaneously such a nutritional shortage arises relatively rapidly in a pregnant woman, since the foetus growing inside of her increases her energy demand.
4. The fasting person’s body experiences a reduced supply of metabolic fuel. Under normal circumstances, glucose is one of the body’s main sources of energy. When fasting, lack of glucose arises (hypoglycaemia or “low blood sugar”). The body may be able to at least partially compensate for this lack of fuel by stepping up the, otherwise sparsely used, process of fat metabolism. Although a shortage in nutrition probably causes the greatest problems to the foetus, an increased fat metabolism is also potentially dangerous.
5. Pregnant women are at an increased risk of reaching states of hypoglycaemia and ketoacidosis, since their own body’s demand for energy is increased by that of both placenta and foetus.
6. In the medical sciences, there is now a wide consensus that many chronic diseases, typical for adults, find their origins in pre-birth conditions such as pre-natal exposure to malnutrition (Harding, 2001). When there is a shortage of nutrition, the foetus will adapt itself to this adverse condition.
7. One important adaptation by the foetus to nutritional shortage is that it will use most of the scarce energy for the most vital organs and their metabolism, so that they will be protected against the lack of fuel. Because particularly the brain will be protected in this way, this process is known as “brain-sparing” (Godfrey & Barker, 2001). This goes at the expense of energy devoted to other organs, muscles and limbs. As a result, cell division in these body parts may be decelerated. Also, resources may be increasingly diverted to placenta growth in order to extract more nutrients, which comes at the expense of resources devoted to the foetal body itself (Barker, 1997).
8. Except for effects on the general growth of the foetus, this is particularly effective on organs which are undergoing their critical growth period: the period in which they are formed or go through a phase of important growth. Even short periods of undernutrition can result in damage to these organs (Barker, 1997). Such damage often does not create problems at once, but only much later in life, as degeneration sustained during the lifetime has an adverse effect. Initially, this does not cause great problems, but when ageing further decreases the number of nephrons, it may result in hypertension and consequent further damage to the kidney (Barker, 2002).
9. Type 2 diabetes may also often appear only much later in life as a consequence of brain sparing: the foetal body responds to a shortage of glucose by increasing insulin resistance. This leads to a decrease in glucose uptake in the body and thus reduced body growth.
10. Both hypertension and type 2 diabetes are major risk factors for developing coronary heart disease. Coronary heart disease has often been associated with low birth weight. Birth weight is typically lower if the mother experienced malnutrition during pregnancy (Barker, 1997), but it captures only part of the changes of the foetal body to maternal nutrition.
11. Beside brain sparing, there are other ways in which the foetal body can adapt and react to nutritional shortage. A potentially important role is played by maternal undernutrition acting as a stressor. In this capacity, it stimulates an increase in maternal concentrations of the stress hormone CRH (corticotropin-releasing hormone). These elevated levels prepare the foetus for an expected preterm delivery: foetal growth is reduced, but at the same time, tissue maturation is accelerated (Hermann et al., 2001; Hobel & Culhane, 2003). Exposure to stress hormones before birth may also program the hypothalamic-pituitary-adrenal (HPA-) axis: a system that controls much of the hormonal system, including reactions to stress. The alterations to the HPA-axis and its responses resulting from this programming have been associated with higher blood pressure and type 2 diabetes (Seckl & Holmes, 2007).
12. Beside general theories on how adaptations of the foetal body to nutritional shortage may lead to long-term negative health consequences, negative effects of observing Ramadhan may also come from higher incidences of hyperemesis gravidarum (excessive vomiting during pregnancy) during this month (Rabinerson et al., 2000) and from a refusal to take prescribed drugs during daytime (Leiper, Molla & Molla, 2003). Potentially, peaks in the blood glucose level caused by the consumption of large amounts of sweet products in the evening may lead to major congenital anomalies in the children (cf. Schaefer et al., 1997).
13. Dehydration generated by restricted fluid intake may cause a low amniotic fluid level. This, in turn, has been associated with perinatal death, foetal malformations, preterm birth, low birth weight and poor health at birth (Brace, 1997; Casey et al., 2000).
14. A few obstetricians confirmed that there was an increased incidence of pregnancy problems during Ramadhan: more caesarean sections, cases in which there was a decrease in amniotic fluid or foetal heart rate accelerations and, in the first trimester, a higher incidence of hyperemesis.
15. Another point of concern was liquid and/or food intake. Women had to be advised to drink enough and to eat in a varied manner, healthily and a sufficient quantity.
16. Exposure to fasting before birth is related to poorer general health and a higher incidence of sickness. Also, it increases a person’s chances of developing symptoms that are indicative of serious health problems including coronary heart disease and type 2 diabetes and, among older people who had been exposed during certain stages of gestation, may lead to anaemia. Younger people who had been exposed on average have a higher pulse pressure. A lower percentage of males among those born during, and in the months after Ramadhan, suggests a higher incidence of miscarriages and perinatal death.

Source: sciencedirect

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