First, congratulations! Pregnancy is an exciting time for a woman as her body goes through the changes of each trimester. At the same time, pregnancy puts a lot of strain on a woman’s body. And then, the blessings of Ramadan are upon you….and you’re nauseated! During winter months, when the day is 10-12 hours, fasting is not as concerning an issue as it is during the summer months. Of course, nutrition and hydration are always important in pregnancy, but a 10 hour fast is not that much longer than the recommended 8 hours of sleep at night (for which we don’t give women any guidelines). Nor is it much longer than the required 8 hours fast before the glucose test for diabetes that we ask all women to do at the end of their second trimester. When women are scheduled for cesarean sections, they are routinely advised to fast (no water, no food) for 8 hours. So really, the question is about fasting long, hot days.

This Ramadan (2019) will start in early May and the fasts will be from 15-16 hours. Fasting during pregnancy brings up a lot of questions.

Every pregnancy is different. Each person has different medical issues, different weight issues, and different issues with their pregnancy, If they’ve heard of it before, they’ll probably already have recommendations for you. If not, it’ll give them some time to look into it, or to ask other colleagues for some guidance. But it’s definitely something you want to bring up and something you want to decide with your doctor.so please bring up fasting during one of your appointments; ideally 2-4 weeks before Ramadan begins.

Next, remember that in the shariah fasting is required in Ramadan. When you are pregnant, you may take an exception or rukhsah and not fast. So, if you can, the default is to fast. And if you think it’s hard to fast pregnant in the summer, try fasting in the summer while you’re nursing and with a baby around (which is where you’ll be in Ramadan one year from now!). So, unless you want to be sitting there with several years in a row of Ramadan to make up, you should really try to fast as much of Ramadan as you can.

A lot of what you can do depends on how far along you are in your pregnancy. Absolutely, the hardest time to fast is in the first 6-14 weeks of pregnancy. This is when the stomach causes the most trouble with nausea, vomiting, queasiness, reflux, etc. Some patients have quite minimal symptoms, while others need regular medications. If you’re in this stage of pregnancy, and you have been eating every 1-2 hours just to keep the nausea at bay, fasting may not be reasonable. Rest assured, some patients who can’t fast the first two weeks of Ramadan are able to by the time the last 10 days come around.

Of course, there are exceptions, but as you can tell, I generally encourage my patients to fast in Ramadan. If you feel well and want to fast AND your physician agrees it’s safe to fast for you and your specific health conditions this pregnancy these are rules (not guidelines) I give to my patients:

1. You must be up for sahoor (the pre-dawn meal) and must have 1 liter of water during that time. It’s hard to drink that much that quickly, so give yourself time. Something that also works, is to drink a glass, pray 2 rakah, drink a glass, etc.
2. You must have another liter of water after iftar, before you sleep.
3. If either of the above are not done for that particular day, you should not fast that day.
4. During the day, be aware of signs of significant dehydration.
   1. Lightheadedness or dizziness that lasts more than 30-40 seconds. Should this occur, you should break your fast and start drinking water.
   2. Another sign of dehydration after 20-24 weeks of pregnancy is contractions. Sometimes, when the body is dehydrated, the uterus starts to contract. So for women further along in their pregnancy, if you start to feel regular contractions or cramping, you should break your fast and start drinking water.
5. Weigh yourself once a week, just before sunset, with either the same clothes or no clothes. You should not be losing weight. If you do find you are losing weight, then you should consider fasting every other day, or two out of three days so that you can keep up adequate nutrition for your growing baby.

There are increasingly available studies reviewing the affects of fasting in Ramadan on pregnancy outcomes. None of the studies are ideal for drawing exact, strong conclusions as different parts of the world during different seasons have different temperatures and lengths of fast. I’ve included a few with data that are both statistically and clinically significant:

• The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis. Glazier JD et al. BMC Pregnancy Childbirth. 2018 Oct 25;18(1):421. doi: 10.1186/s12884-018-2048-y.
  • Large review of 22 studies including 31,000 women, 18,000 of whom fasted in Ramadan.
  •  Results show that fasting does not affect birth weight or preterm delivery. Placentas did have lower weights in fasting women, roughly 15% lighter (average placental weight 500g).
• Ramadan fasting and newborn’s birth weight in pregnant Muslim women in The Netherlands. Savitri AI et al. Br J Nutr. 2014 Nov 14;112(9):1503-9. doi: 10.1017/S0007114514002219. Epub 2014 Sep 18
  • Small study of 130 women, but in the same year in the same country which has excellent national records.
  • Results show that strict adherence to fasting in Ramadan during the first trimester was associated with a 270g lower birthweight. However, if Ramadan was in the second or third trimesters, fasting did not affect birthweights.
• Intellectual development of children born of mothers who fasted in Ramadan during pregnancy. Azizi F et al. Int J Vitam Nutr Res. 2004 Sep;74(5):374-80
  • Small, retrospective study of 191 school-aged children. Detailed questionnaires filled out by mothers were used to include socioeconomic as well as fasting information.
  • Results showed no difference in IQ scores between children who’s mothers fasting during pregnancy and those who did not.

And God knows best.

DISCLAIMER: Information in questions, answers, and other posts on this site are for general information and are not intended to substitute for informed professional medical advice, and do not establish a physician-patient relationship. The site is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.