gms | German Medical Science

Background: Research on in-utero exposure to Ramadan found long-term negative health effects among the offspring including higher risks for symptoms indicative of chronic diseases such as type 2 diabetes and coronary heart disease [1] and higher rates of learning disabilities [2]. While the effects are generally attributed to fasting, other aspects of Ramadan observance may also play a role. Studies in predominantly Muslim countries find that generally, a majority of women fast. However, fasting practices among pregnant Muslims in Europe remain largely unknown. Given that about 5% of the German population adhere to Islam – which is expected to increase in the future - the health impacts of Ramadan during pregnancy are important for a relevant subgroup of the population.

Aim of the study: First, we aim to find out how many Muslims in Mainz observe Ramadan during their pregnancy and how women who fast as well as who do not fast experience Ramadan. This is the first study to collect data on Ramadan behavior in Germany. Second, by linking the survey data to birth outcomes, we study the relation of behavior during Ramadan to the health status of the offspring. To our knowledge, our project is the first study that explores whether other behavioral changes during Ramadan besides actually fasting, such as sleeping less, might affect the offspring's health. This will allow for a better understanding of what aspects of Ramadan may lead to adverse health outcomes.

Proposed methods: A survey study is conducted in the two obstetric wards in Mainz (Germany) from May 2017 onwards. During a pilot phase in 2016, 116 interviews were conducted. We aim at interviewing at least 300 additional women during the main study. All Muslim women are approached, whether or not they fasted. Participants are asked to sign an informed consent, allowing us to link their medical records with their interview. In addition to asking about fasting behavior, our survey includes questions about sleeping patterns and changes in nutrition, even on those days on which women did not fast. We furthermore want to understand why women in Germany decide to fast or not to fast. Lastly, personal details are collected, including the country of origin and the amount of time spent in Germany. This last question is of particular interest to identify recent refugees, in order to complete heterogeneity analysis.

Points for discussion: First results from the pilot study show that 42.7% of all interviewed women decided to fast for at least one day during their pregnancy, among those 54% for 20-30 days. For all fasting women, fasting implied forgoing food and drinks during daylight hours. 23% of the interviewed women were born in Germany and among those, 37% fasted. Consequently, the practice of Ramadan during pregnancy seems to be a relevant issue in Germany. 18% of the interviewed women fasted even though they expected negative effects on the unborn child while most fasting women (56%) indicated that fasting during pregnancy does not have an effect on the offspring. Moreover, the advice of gynecologists reported by our interviewees indicates that not all practitioners are aware of potential harmful effects of fasting during pregnancy.

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