Ramadan is one of the most wonderful times in the Islamic calendar

Ramadan is a time of physical and spiritual renewal. It is a time to connect with family, a time to celebrate with community, and to share the blessings we have with others. Ramadan helps Muslims increase their spirituality, reflect on their year, plan for the year ahead and improve their relationship with the Divine.

Fasting from dawn to dusk makes this month incredibly immersive and unique. Many look forward to fasting all year and anchor their year around this beautiful holy month.

As Muslims follow the Lunar Calendar, the timing of Ramadan changes every year. In Australia in the next few years, Ramadan will be in the longer days, meaning that Muslims would fast up to 17 hours from food and water.

If you’re pregnant this Ramadan, you should discuss fasting with your healthcare provider

Fasting during pregnancy is a very individual choice medically and religiously.

You should consult with your healthcare provider to support you to make your choice.

You may discuss your medical history, the stage of your current pregnancy, whether you have gestational diabetes, the duration of fasting in your city and your risk of dehydration to help you make that choice.

Pregnant women are performing sacred work!

Pregnant women are performing incredibly sacred work by caring for a vulnerable foetus. They are sharing their body to provide warmth, nutrition and caring love.

Their work is so honoured by Allah and they earn spiritual rewards for every single moment of the pregnancy.

If you decide not to fast after discussing it with your doctor, you can certainly participate in other religious activities (such as reading Quran out loud to the baby in the womb, attending the masjid, or working on self-improvement) to help you celebrate this holy month.

In Islam, actions are judged by their intentions. Prioritising our baby’s wellbeing over our own wishes to fast is a noble sacrifice that will be greatly rewarded, inshallah.

In all Schools of Thought in Islam, pregnant women are exempt from fasting if there is a medical risk to them or the unborn baby.

An overview of the Medical Evidence

The medical evidence on Fasting in pregnancy has shown that whilst there may not be a short term impact on the baby, there may be harm in the long term.

In the short-term, studies show that there is no consistent negative impact found. There is likely no impact on foetal weight, or prematurity. This means that if you fast during Ramadan during pregnancy, it’s not likely that the baby’s weight will be impacted, and it’s not likely that your baby will be premature.

In the long-term, however, there might be an adverse impact.

88% of the studies assessing the long-term impact of Ramadan fasting in pregnancy (14 out of 16) have shown some serious potential effects. These adverse effects are detailed in the table at the end of the article. However, in summary, they show:

1. Higher likelihood of child death: foetal death (more likely if the baby is male), higher likelihood of death before 3 months, before 1 year and before 5 years of age
2. Higher chance of intellectual disability
3. Worse adult health: increased likelihood of Type 2 Diabetes Mellitus, heart disease, and wheezing diseases
4. Worse school performance in English, Maths, and others
5. Lower height than expected for age and genetic potential

A note on the quality of the long-term medical evidence

While all the studies assessing the long term risk are classified as ‘medium to low’ quality, researchers and doctors would say that there is likely a negative outcome as we can see an overall pattern in the available research.

There are zero studies of high quality available at the moment that look into long term effects of Ramadan fasting in pregnancy. Until high-quality research is available, our medical decision making has to rely on the available research.

It might be safer for you not to fast in pregnancy until more research is done in this space. Please discuss this with your healthcare provider and trusted religious scholar to help you make your decision.

How does fasting lead to adverse outcomes?

In short, we don’t know yet! However, we know that the foetal brain depends on glucose from the mother for its growth. When a pregnant mother fasts, her body runs out of glucose much faster than a non-pregnant adult. This is because pregnant bodies have a higher demand for energy as they are creating a new human being, as well as changing their own body for this journey. Thus, pregnant women’s bodies run out of glucose quickly and deprive the growing fetal brain of the glucose it requires to grow.

This may be why we see the greatest effects of fasting on the fetus’ brain – intellectual disability and lower school performance.

Your Baby develops most of its bodily systems in the First Trimester

As the foundation for most bodily structures is being laid out in the first trimester, the first trimester might be the most important time not to fast.

Many people assume it’s the opposite, and that because the fetus is so small, there won’t be an impact. However, research seems to show that the first trimester is the most critical time. The fetus, and especially the fetus’ brain, need regular, reliable glucose available.

Mothers who are in their first trimester during Ramadan should discuss their fasting choices with their healthcare provider. If you choose to fast, please consult your doctor about fluid intake and calorie-dense foods to consume at Suhoor and Iftar times.

Sleep and rest are also important during pregnancy

During Ramadan, even if we’re not fasting, we still eat less – ask any menstruating woman! This is because there are no reminders around us to eat and no social cues to eat.

All pregnant women need to eat small, regular meals to ensure that sufficient glucose is being delivered to their babies. You might find it beneficial to have crackers around the house or a reminder on your phone to eat some fruit.

Sleep is also a critical element that gets disrupted in Ramadan. Many parents of young toddlers or people who work long hours might find themselves trying to survive on 4 hours of sleep between Taraweeh, family meals, and suhoor.

It’s absolutely imperative that you get enough sleep during pregnancy. You might need to reduce your work hours, utilise daycare more, or call on family to support you to ensure that you get sufficient sleep to protect yourself and your baby.

Consult your healthcare provider

In summary, even if you feel physically capable of fasting during your pregnancy, this may not reflect your baby’s wellbeing.

We recommend discussing your own case with your healthcare team (GP, midwife, Obstetrician and others) to help you make your decision.

Our Rahma team and your medical team will always support you no matter what decision you make.

Pregnancy during the Holy Month of Ramadan

Note 1: This article is intended for a Muslim audience. Please consult the glossary at the end for an explanation of the Arabic terms used. Rahma Health is not an Islamic organisation; however, this article was written by our team members who are practicing Muslims and who observe Ramadan.

Note 2: There is significant diversity within the Muslim community, and this article offers general advice only. Please discuss your individual case with your trusted religious scholars and your healthcare team.