Introduction
Fasting is the willful abstinence of food, water, or both. It is
practised globally for therapeutic, religious, political or cultural
reasons.1 It can be broadly categorized into complete
or partial fasting, intermittent fasting, and fasting based on
duration.2
Ramadan is a month of prayer, community, reflection, and fasting for
Muslims, which falls on the ninth month of the Islamic
calendar.3,4 Abstaining from sinful behaviors and RF
are believed to cleanse the soul, divert the heart from worldly
activities and instil self-discipline.4 RF is a form
of intermittent fasting lasting from sunrise to sunset, but unlike
intermittent fasting where consuming zero-calorie fluids is allowed, RF
is more intense, entailing total abstention from food and
water.4 There is a major shift from normal eating
habits to exclusively nocturnal eating.5 It is
non-mandatory for those who are ill, elderly, travelling, menstruating,
breastfeeding, and pregnant. However, they are compelled to substitute
missed days.3 Ideally, fasting during pregnancy is not
advised, but there are some who still practise it during
Ramadan.6
As the oldest and most commonly employed method to evaluate fetal
well-being, maternal awareness of fetal movements is reliable and done
without medical equipment.7 It is linked with improved
perinatal outcomes, as concerned mothers present themselves for
assessment once reduced fetal movement is detected. At least 10 fetal
movements in 12 hours is considered normal.8Nevertheless, a decrease in fetal activity during Ramadan appears less
uncommon. Studies have hypothesized that nutritional deficit may
contribute to reduced fetal movements to conserve energy as it
compensates for lack of nutrient transfer across the
placenta.9
There are concerns that RF during pregnancy may cause adverse maternal
or neonatal outcomes. For this review, we centred around fetal health
rather than maternal health. To date, there is insufficient evidence
linking RF and pregnancy. Existing evidence do not show significant
association.10,11 Considering that normal fetal
movement is highly specific and objective measurement of fetal
viability, it is reasonable to include fetal movement as an outcome
measure.
Before suggesting that RF during pregnancy is safe, it is important to
have conclusive data that allows health professionals to provide firm
recommendations. Consequently, we conducted this systematic review to
gain clearer insights into the effects of RF on fetal health.