Ramadan: To fast or not to fast during pregnancy

Sunday April 26 2020
health01pix

The safest period for fasting is between the 12 to 24 weeks. NET PHOTO

By Abdul-Nasser Ssemugabi

Halima Ndagire is a mother of three boys, a practicing Muslim, married and an educator. She knows that Islam exempts her from fasting when she is pregnant but for the immense rewards of fasting during Ramadan and the fear to fast alone, she observed fasting some days while pregnant with her second child.
“I did not want to miss the rewards, Ndagire says during a phone interview. “But I did it for some days.”

For Aisha Nakato, it was sheer sacrifice. “We were in a dire situation financially and I attempted something special for Allah to answer my prayers,” says the proprietor of Life After School Foundation and mother of three girls and two boys.

“I fasted one day but towards dusk I started feeling dizzy, headache and severe hunger. I gave up,” she adds.

Nakato says she has a huge appetite during pregnancy and she never tried fasting again. However, she told us, her elder sister observed fasting while pregnant for more than a week, and her child did not get any problems.

The Quran
From several Quranic verses and teachings from the Prophet Muhammad (Peace Be Upon Him), Sharia specialists agree that pregnant and breastfeeding women may break their fast in Ramadan, if they feel fasting might injure them or their babies, but must make up for the missed days or feed a needy person for every day missed.

But Sheikh Kassim Kiyingi of Bilal Islamic Institute, warns women not to abuse this right. He insists that unless medics have proven the potential danger to the pregnant woman or to the unborn child, it is best for them to fast.

“But if a pregnant or breastfeeding woman foregoes fasting, and has the ability to feed the needy, she should do it, but when she gets the time to fast afterwards, she should fast. Feeding the needy is good but does not make up for the days missed, unless you do not get the time to fast,” he says.

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There are controversies over the effects of Ramathan fasting on pregnancy outcomes, and women’s opinions differ.

Second trimester is safer
To simplify this puzzle, we asked a Muslim obstetrician, who is also a mother. Hajjat Neema Nassolo, of Health Sense Medical Centre at Muganzirwazza Plaza in Katwe, says when a pregnant woman asks for her opinion on fasting, the first thing she tells her is “Islam exempts you from fasting, but it depends on how you feel.”

She adds: “Because different pregnant women face different experiences.” For instance, she says, if one experiences excessive vomiting, fasting is a bad idea since she will be dehydrated if she goes hours without taking in fluids.

The safest period for fasting, she says, is between the 12 to 24 weeks (three to six months.
“Because normally the vomiting has stopped, and the baby does not need many nutrients from the mother.”

From October 2017 to January 2018, researchers from Hawler Maternity Teaching Hospital of Erbil, Iraq studied Iraq women particularly to assess the perspectives and pregnancy outcomes of maternal Ramadan fasting in the second trimester of pregnancy.

The findings of the study published in the BioMedical Centre journal of April 15, 2019, showed that fasting during the second trimester of the pregnancy decreased the risk of gestational diabetes and excessive weight gain during pregnancy.

But Nassolo says in the last three months to delivery, the baby gains more weight and other changes, which require more glucose.

“So,” she warns, “the pregnant mother is not advised to fast because this might result in intrauterine growth restrictions and low birth weight.” She adds that the mother experiences frequent hunger during this period, and can collapse because the baby consumes too much of her iron, which makes fasting harder.

Risks to baby
A BBC story published August 12, 2010, cited a study by scientists in the United States, based on census data from the US, Iraq and Uganda, who found that pregnant women who fast are likely to have smaller babies who are more prone to learning disabilities in adulthood.

But Ndagire begs to differ. She says during her first pregnancy, she mostly depended on water, with no appetite for food. But her baby was born with a normal weight, and is now a healthy 13-year-old boy.

Some of Nassolo’s clients insist on fasting throughout their pregnancies but some lose their babies. The gynaecologist explains: “In the third trimester, we recommend small frequent meals.

But when a mother is fasting she cannot eat enough in one meal. Sometimes, she can even miss the predawn meal yet she is going to fast the whole day. When the baby does not get the nutrients they need, they may die.” The bottom-line: “We cannot issue a blanket decree that pregnant women cannot fast, because we know the importance of fasting to Muslims. We advise accordingly.”
 
Breastfeeding
Here is the dilemma: Islam recommends breastfeeding a child for two years, but does not specify when to supplement breast milk.

“However,” Nassolo says, medically, we recommend the first six months of breast milk, exclusively, without any external foods.” So a mother can only consider fasting after those six months because she gets the breast milk from the food she eats.

“But that’s ideal,” she says, “Because some introduce their babies to supplementary milk even at three months.” Now to such mothers, Sheikh Kiyingi says they should observe fasting. The inconvenience of fasting alone when others are not is partly why many women fast during pregnancy and breastfeeding.

To allay these fears which could be costly, Nassolo shared her personal experience:
“Twice I have been a caught in the same dilemma. The first time I could not even dare fast because I was in the first trimester. The second found me breastfeeding. But I do not stress myself. I have a strong faith and conviction to make up the days I missed, before another Ramadan falls.”

However, for a woman to fast outside Ramadan, she needs her husband’s permission. “My husband is very supportive. I fast every Monday and Thursday and he also observes optional fasting on the same days. So it is very easy for me,” she says.

Ndagire thinks the choice to fast or otherwise, is psychological because her conditions do not permit her to eat as recommended during pregnancy but her children are born and meet all growth milestones.

She also fasts while breastfeeding but she has never run out of breast milk. Yet Nakato, who even overeats during pregnancy struggles to get breast milk even though she does not fast.

assemugabi@ug.nationmedia.com

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