Pregnancy

Most women worry about the potential adverse effects of fasting, both for themselves and their unborn children. This is especially true for pregnancies in the first and last trimesters when the greatest demands on the body take place.

Many women are unwilling to take any risks when it comes to their babies. This is certainly a most praiseworthy attitude with regards to our health and children, but when it comes to fasting this approach alone is not a valid reason not to fast. We have established in the fiqhi rulings section that worries alone are not a sufficient excuse or automatic exemption from fasting, rather, fear of serious harm has to be perceived or expected based upon personal experience or sound medical advice.

We aim to determine whether there is a cause for concern, a potential for serious harm or risk and at what stages in pregnancy they are applicable that would therefore exempt pregnant women from fasting.

Ramadaan falling in the summer, with long fasts on hot days, is the immediate concern for pregnant women, their family members and health care providers. Morning sickness can add to problems with keeping hydrated. Feeling nauseous itself is obviously not a serious harm, but persistent nausea that is debilitating, especially if there are other children to look after and prepare meals for, needs medical attention. Certain levels of nausea are alleviated by eating small, regular amounts.

Repeated vomiting that could lead to dehydration certainly could be harmful. Sufficient fluid intake for anybody fasting is necessary, and for pregnant women it is a must. We would encourage everyone to remain alert about any warning signs of dehydration, namely feeling light-headed or dizzy, breaking their fast if symptoms persist or worsen. 

If adequate food and drink cannot be taken at iftar and suhoor (and in between), or if one vomits after their meals, fasting may not be possible until this settles. Vomiting any quantity does not break the fast,  even if it an entire meal, it is the lack of nutrition and hydration that would be of concern.

Aside from early pregnancy complications due to sickness and hydration there are no other major concerns regarding maternal health in societies where food is abundant, alhamdulillah.

There is a growing body of research indicating that fasting does not cause us or our babies harm. More specifically, fasting does not induce early labour or increase the risk of premature babies[1], nor does it affect birth weight[2] [3]. The same studies and others [4] also show this remains true for every stage of pregnancy during which Ramadaan occurs; fasting in early or late pregnancy has no disadvantageous impact on labour and birth.

Detailed measures of estimated foetal weight gain, the tiny heart and its functions[5] [6], the umbilical cord[7], the placenta[8] and amniotic fluid[9] have all been studied and any changes that have been reported in the mother[10] or foetus have not been shown to be damaging.[11]

The findings can often be astounding, with some authors even confidently concluding that “fasting during Ramadan does not lead to maternal ketonemia or ketonuria[12] in pregnant women. In addition, fasting during Ramadan has no significant adverse effect on intrauterine fetal development or the fetus’s health.”[13]

This is not to say that fasting cannot and does not affect pregnant women. Fasting can be difficult for any person and produce “increased irritability and incidences of headaches with sleep deprivation and lassitude (weariness or a lack of energy).” However, there are few serious health problems that are attributable to fasting itself and none that are known to be specific to pregnant women. This means that there are also very few cases where the exemption for fasting when pregnant is applicable for otherwise normal pregnancies.

It is important to bear in mind that the sick person is exempt from fasting under certain conditions and we need to be particularly wary of this during pregnancy. It is worth noting common conditions and illnesses [14] when pregnant and what doctors perceive as being severe and with which fasting should be left.

The above research is based upon healthy women with straight forward pregnancies. If there are any complications or health problems then this advice is not applicable and it is our duty to act upon personal medical advice in such cases. This would include pregnancy-specific conditions such as gestational diabetes and pre-eclampsia.

Muslim women across the globe continue to observe fasting whilst pregnant in countries as diverse as Turkey, in rural African villages [15] and Singapore where “most of them do not experience any adversities during fasting and even if they do, most were able to overcome them.”[16] We have also found similar experiences when collecting personal accounts of fasting in Ramadaan (see ‘Personal accounts’).

Generally, pregnancies continue as normal during Ramadaan although some women may have a little weight loss. Not all women will actually lose weight [17] as it is easy to continue to consume the same amounts of energy when fasting and not fasting. It is important to ensure that we are not only meeting pure energy intakes but are choosing healthy balanced meals. A poor diet is more likely to affect the mother than her baby.

Long-term effects of Ramadaan fasting during pregnancy, beyond the effects in utero and at birth, are in their primary stages of study and authors in this field state that they are far from being in a position to extrapolate or to set guidelines and parameters in decisions on fasting[18].

We do have some evidence, such as measuring intelligence in children aged 4 to 13 using appropriate IQ tests, that have found no adverse effects of fasting during pregnancy.[19]  What research has been published showing negative long-term effects is based on weak statistical correlations without any evidence of causation and in contrast to clear medical advice.[20] Because a disproportionate amount of attention has been given to these handful of fringe studies, there is a fuller discussion of them in the appendix.

We reviewed over 40 papers[21] and believe that in the light of current research, fasting in normal, healthy pregnancies is safe, at any stage of pregnancy.

In conclusion, we provide a statement from the British Journal of Midwifery: “It would appear that most health care professionals advise against fasting during pregnancy… in the light of available research, Ramadaan fasting has no long-term effects on normal healthy mothers or their full term offspring.”[20]

“Then when you have reached a firm decision, put your trust in Allah.” (Surah Aale-Imran, verse 159)

“Whoever puts his trust in Allah; He will be enough for him. Surely Allah brings about what He decrees; Allah has set a measure for everything. (Surah Talaq, verse 3)


[1] Awwad, J., I. M. Usta, et al. (2012). “The effect of maternal fasting during Ramadan on preterm delivery: a prospective cohort study.” BJOG 119(11): 1379-1386.

[2] Cross, J. H., J. Eminson, et al. (1990). “Ramadan and birth weight at full term in Asian Moslem pregnant women inBirmingham.” Arch Dis Child 65(10 Spec No): 1053-1056.

[3] Kavehmanesh, Z. and H. Abolghasemi (2004). “Maternal Ramadan fasting and neonatal health.” J Perinatol 24(12): 748-750.

[4] Ozturk, E., O. Balat, et al. (2011). “Effect of Ramadan fasting on maternal oxidative stress during the second trimester: a preliminary study.” J Obstet Gynaecol Res 37(7): 729-733.

[5] Hizli, D., S. S. Yilmaz, et al. (2012). “Impact of maternal fasting during Ramadan on fetal Doppler parameters, maternal lipid levels and neonatal outcomes.” J Matern Fetal Neonatal Med 25(7): 975-977.

[6] Mirghani, H. M., M. Salem, et al. (2007). “Effect of maternal fasting on uterine arterial blood flow.” J Obstet Gynaecol Res 33(2): 151-154. see also Mirghani, H. M., D. S. Weerasinghe, et al. (2003). “The effect of maternal fasting on the fetal biophysical profile.” Int J Gynaecol Obstet 81(1): 17-21 where they report reduced no changes with the exception of reduced feotal breathing movements which are infrequent or absent in late pregnancy anyway. The foetus most likely adopts a new sleep-wake cycle just like its mother.

[7] Dikensoy, E., O. Balat, et al. (2009). “The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development.” Arch Gynecol Obstet 279(2): 119-123.

[8]Alwasel et al., (2010) Changes in placental size during Ramadan. Placenta 2010 Jul; 31(7):607-10. doi: 10.1016/j.placenta.2010.04.010

[9] Dikensoy, E., O. Balat, et al. (2008). “Effect of fasting during Ramadan on fetal development and maternal health.” J Obstet Gynaecol Res 34(4): 494-498.

[10] Kiziltan, G., E. Karabudak, et al. (2005). “Dietary intake and nutritional status of Turkish pregnant women during Ramadan.” Saudi Med J 26(11): 1782-1787

[11] Tug, N., H. Ayvaci, et al. (2011). “Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores.” Arch Gynecol Obstet 283(3): 461-467. Fasting decreased BPP reversibly, but not to a level below 8/10.

[12] Ketonemia: excessive ketone bodies in blood. Ketonuria: ketone bodies are present in the urine. Ketones indicate that the body is using an alternative source of energy and is therefore found during starvation.

[13] Dikensoy, E., O. Balat, et al. (2008). “Effect of fasting during Ramadan on fetal development and maternal health.” J Obstet Gynaecol Res 34(4): 494-498.

[14] For examples, see the chapter on common illnesses in pregnancy in the Queens Charlotte’s hospital ‘Guide to Pregnancy and Birth’ which can be viewed online on Amazon using the search inside this book function:http://www.amazon.co.uk/Queen-Charlottes-Hospital-Guide-Pregnancy/dp/0091815959#reader_0091815959.

[15] Prentice, A. M., A. Prentice, et al. (1983). “Metabolic consequences of fasting during Ramadan in pregnant and lactating women.” Hum Nutr Clin Nutr 37(4): 283-294.

[16] Joosoph, J., J. Abu, et al. (2004). “A survey of fasting during pregnancy.” Singapore Med J 45(12): 583-586.

[17] Leiper, J. B. and A. M. Molla (2003). “Effects on health of fluid restriction during fasting in Ramadan.” Eur J Clin Nutr 57 Suppl 2: S30-38.

[18] Van Ewjick, R. J. G. et al. (2013). “Van Ewijk et al. Respond to Ramadan Prenatal Fasting” Am. J. Epidemiol. (2013)177 (8): 741-742.

[19] Azizi, F., H. Sadeghipour, et al. (2004). “Intellectual development of children born of mothers who fasted in Ramadan during pregnancy.” Int J Vitam Nutr Res 74(5): 374-380.

[20] Cross-Sudworth, F (2007) Effects of Ramadan fasting on pregnancy. British Journal of Midwifery, Vol. 15, Iss. 2, 01 Feb 2007, pp 79 – 81

[21] The papers can be found in Appendix ii, see PDF on the You Decide page

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