Pregnancy and fasting during Ramadan SIR,-Awad H Rashed' and Jane Reeves2 have discussed fasting by pregnant women during Ramadan. I worked in the Republic of Yemen for over 10 years on various projects in both inner city slums and remote rural areas. Pregnant women often fasted during Ramadan even though they did strenuous physical activity, such as collecting water or working in the fields. In my experience lack of knowledge about exemption from fasting during Ramadan was not the most important issue. The main problem was that the women did not want to have to make the time up later, when they would be the only member of the household fasting. They preferred to fast in Ramadan, even though it made them tired and in some cases weak, because they wanted to participate fully in the religious festival. They often expressed their dislike of having to fast when no one else in the family was fasting but were adamant in their belief that they must fast for the full four weeks. I even know of a few non-pregnant women who took the contraceptive pill for the complete month of Ramadan, without the customary seven day break, so that they would not have to stop fasting because they were menstruating. I would be interested to know if explaining the current teaching on fasting in pregnancy to Muslim women has any effect on their practice; I remain unconvinced. I would also be interested to know what are the effects of fasting on pregnant women. In Yemen for many women the diet improved in variety and quality, especially in the poorer households, during Ramadan. The main problems cited by the women were the restriction of fluid intake during the day and, especially in the last week of Ramadan, lack of sleep. I agree with Rashed that more thorough scientific attention should be paid to this subject to ensure that we give Muslim women sound, useful advice in accordance with their religion. ANN HOSKINS Department of Public Health, University of Liverpool, PO Box 147, Liverpool L69 3BX 1 Rashed AH. The fast of Ramadan. BMJ7 1992;304:521-2. (29 February.) 2 Reeves J. Pregnancy and fasting during Ramadan. BM7
1992;304:843-4. (28 March.)
Cardiac stress during transurethral prostatectomy SIR,-Julian W H Evans and colleagues report the haemodynamic effects of transurethral resection of the prostate.' Their earlier study of the subject stimulated us to look at it ourselves.2 We compared the haemodynamic changes in 22 patients undergoing transurethral resection of the prQstate under general or spinal anaesthesia. The patients given general anaesthesia received a standardised anaesthetic regimen. Variables recorded included heart rate, arterial blood pressure, and ascending aortic blood flow assessed with Doppler aortovelography (Sci Med). This technique, which is analogous to the Doppler technique used by Evans and colleagues, accurately reflects trends in cardiac output as determined by other recognised techniques.3 In our patients given general anaesthesia the estimated cardiac output fell by a mean of 30% with induction of anaesthesia but returned towards the baseline value before surgical resection started. Once resection began the cardiac output fell by 510%, returning towards preinduction values after 40 minutes. At the beginning of resection mean arterial pressure was 10% below preinduction
9 MAY 1992
values, and it remained at this level throughout resection. The heart rate before the start of resection was 25% below preinduction values and gradually returned to baseline values after 40 minutes of resection. Calculated systemic vascular resistance increased by 40% with induction of anaesthesia but returned to baseline values before resection started and remained stable thereafter. Haemodynamic variables in the patients given spinal anaesthesia were stable throughout the resection. Thus the only appreciable haemodynamic changes that we observed were related to induction of anaesthesia and not to prostatic resection. In our hospital irrigating fluid is warmed to body temperature, and we believe that the changes that Evans and colleagues found may simply reflect the effect of irrigating the bladder with large volumes (> 11 litres per patient) of cool fluid. Evans and colleagues conclude that cardiac stress was increased in their patients through an increase in left ventricular afterload. Left ventricular afterload is determined by left ventricular end diastolic diameter and systemic arterial pressure.4 Alterations in systemic vascular resistance (derived from cardiac output and blood pressure gradient) will affect left ventricular afterload only if they result in a change in arterial pressure. The only estimate of afterload in Evans and colleagues' study was the mean arterial pressure, which did not increase significantly. Also, other important determinants of cardiac workthat is, heart rate and stroke distance-both fell significantly, thus tending to reduce cardiac work. Therefore, we believe that the conclusion is unsubstantiated. P M S DOBSON L D CALDICOTT J COLE S P GERRISH K S CHANNER
Departments of Anaesthesia and Cardiology, Royal Hallamshire Hospital, Sheffield S1O 2JF 1 Evans JWH, Singer M, Chapple CR, Macartney N, Walker JM, Milroy EJG. Haemodynamic evidence for cardiac stress during transurethral prostatectomy. BMJ 1992;304:666-71. (14 March.) 2 Evans JWH, Singer M, Chapple CR, Macartney N, Coppinger SWV, Milroy EJH. Haemodynamic evidence for peroperative cardiac stress during transurethral prostatectomy: a preliminary communication. BrJ Urol 1991;67:376-80. 3 Schuster AH, Nanda NC. Doppler echocardiographic measurement of cardiac output: comparison with a non-golden standard. AmJ Cardiol 1984;53:257-9. 4 Ross J, section ed. Mechanical performance of isolated cardiac muscle. In: West JB, ed. Best and Taylor's physiological basis of medical practice. 12th ed. Baltimore: Williams and Wilkins, 1990:211-21.
SIR,-Julian W H Evans and colleagues noted large increases in mean arterial pressure and systemic vascular resistance within two minutes of starting prostatic resection compared with values in controls undergoing herniorrhaphy.' These increases, they postulate, are secondary to the release of a vasoactive compound from the prostate. Baseline blood pressure and aortic blood flow (oesophageal Doppler ultrasonography) were measured, and systemic vascular resistance and cardiac output calculated, after induction and before surgery, but the group having prostatectomy had been put into the Lloyd-Davies position. This would considerably increase venous return, with a compensatory inhibition of vasoconstrictor autonomic outflow via atrial and pulmonary volume receptors and baroreceptors. The study group would therefore have a lower baseline systemic vascular resistance compared with the controls and a variable baseline cardiac output depending on the response to the autotransfusion. If a vasoconstrictor stimulus is applied to both groups it may have a more profound effect on the study than the control group; certainly the two groups would not be comparable.
The authors then exclude a pressor response to surgery by saying that no lacrimation, sweating, or tachycardia was seen. These are, however, relatively coarse signs seen in response to somatic afferent stimulation. Autonomic afferent activity is involved in hormonal responses to surgery2 and is not blocked without an extensive extradural technique. So a degree of vasoconstriction may occur secondary to released catecholamines, as well as in response to autonomic efferent activity, without much lacrimation or sweating. The authors suggest that these haemodynamic changes predispose to cardiac stress and difficulty tolerating irrigation loads and hypothermia. If indeed these changes are related to increases in venous return perhaps invasive monitoring of central venous pressure should be considered more often, or even measurement of pulmonary artery pressure and cardiac output, as this would give more information than ultrasonography alone. A similar study with patients undergoing prostatectomy under extradural anaesthesia would be interesting. S N GOWER St George's Hospital, London SW17 ORE 1 Evans JWH, Singer M, Chapple CR, Macartney N, Walker JM, Milroy EJG. Haemodynamic evidence for cardiac stress during transurethral prostatectomy. BMJ 1992;304:666-71. (14 March.) 2 Analgesia and the metabolic response to surgery [editorial]. Lancet 1985;i:1018-9.
AUTHORS' REPLY,-We are pleased that P M S Dobson and colleagues agree with our hypothesis that cold stress could be an important factor in causing perioperative circulatory disturbances. Indeed, we are about to submit for publication a report of a further study confirming this concept. The changes seen in our patients having transurethral prostatectomy could be explained by a primary increase in afterload with a secondary fall in cardiac output or by primary myocardial dysfunction with compensatory vasoconstriction. As no changes were seen in the control group, who received a similar anaesthetic and had stable core temperatures, we suggested that rapid central cooling causing vasoconstriction together with increases in whole blood viscosity was the primary event. In response to S N Gower, the legs are raised only minimally in the Lloyd-Davies position compared with the lithotomy position. Therefore increases in venous return are unlikely to be important. We did not suggest that the haemodynamic responses predispose to cardiac stress, but that they are a reflection of it. We cannot agree with Gower's recommendation for more frequent monitoring of central venous pressure as changes in ventricular compliance and peripheral vascular tone will disrupt any relation between right ventricular end diastolic pressure and volume. Pulmonary artery catheterisation should not be regarded as a routine procedure in these patients in view of its morbidity, cost, and
logistical imnplications. J W H EVANS N MACARTNEY M SINGER
J M WALKER C R CHAPPLE E J G MILROY
Middlesex Hospital, London WIN 8AA
Psychological treatments in cancer patients SIR, -Steven Greer and colleagues present further compelling evidence to suggest that a large proportion of patients diagnosed as having cancer suffer from psychological problems and that these problems are eminently treatable with psychological therapy.' Given the overwhelming
Women who are pregnant and do not fast out of worry for their health and safety can compensate by fasting on other days (qadha') to make up for the days they have missed. Women who are pregnant and do not fast for fear of their child's health will be required to do qadha' and pay fidyah.Can a pregnant woman fast during Ramadan in Islam? ›
Islam clearly exempts fasting in Ramadan during sickness, pregnancy, and breastfeeding.What does the Quran say about fasting while pregnant? ›
Islamic law gives permission for pregnant and breastfeeding women to opt out of fasting if she fears that it will harm her health or the health of her baby.Can you fast Ramadan while pregnant first trimester? ›
Islamic law says that pregnant and breastfeeding women are not expected to fast during Ramadan. But, when you are used to fasting every year, and family or friends around you are all fasting, it's understandable to feel like you're missing out! Remember, choosing not to fast keeps you both well and safe.How long should a pregnant woman fast? ›
Although fasting at any point during pregnancy is not advised, fasting in the critical period between 22 and 27 wk of pregnancy may be particularly risky. Pregnant women should be advised against fasting in the second trimester to reduce the risk of preterm birth.What type of fasting can a pregnant woman do? ›
For the 3 less strict fasting days, pregnant and breastfeeding women are exempt from fasting. On the 2 more stringent fast days (Yom Kippur and Tisha Ba'av), observant pregnant and breastfeeding women who are otherwise healthy can consider fasting. You should talk to your doctor or midwife before you fast.Does fasting affect baby during pregnancy? ›
We recommend that you don't fast during pregnancy for the health of you and your baby. However, it is a personal decision and if you do decide to fast, it's a good idea to speak to your midwife or doctor to get their advice.Can babies fast in Ramadan? ›
Abstract. Fasting during Ramadan is obligatory for all able bodiedadult Muslims. Though children are exempt from fasting, many children (and their parents) do observe the Ramadan fast. Responsible diabetes care professionals are expected to offer appropriate and pragmatic advice to children in their care.Who can skip fasting in Ramadan? ›
In Islam, there are several excuses for not fasting Ramadan, including prepubertal children, women during their menstrual period or postnatal bleeding, travelers, pregnant or breastfeeding women who believe fasting for long hours may cause harm to either themselves or their babies, the elderly who cannot tolerate ...Do breastfeeding moms fast during Ramadan? ›
If women are exclusively breastfeeding their babies, they are not expected to fast during Ramadan. Most Muslim scholars believe that women who are breastfeeding have permission not to fast.
رَبِّ هَبْ لِي مِنَ الصَّالِحِينَ – “My Lord, grant me [a child] from among the righteous.”Can you do a 12 hour fast while pregnant? ›
So, intense fasting is a no-go for pregnant women (more on that later). But the only type of fasting that may be safe for women who aren't too far along in pregnancy is an overnight fast, for about 12 hours maximum.What is the dawn rule of 10 in pregnancy? ›
5 time checkups for normal pregnancy,10 times or more checkups for high risk pregnancy,started checkups since 10th week,18th week,24th wk,28th wk, 32th.Is it bad to go 12 hours without eating while pregnant? ›
Specific recommendations on how long you can go without eating vary during pregnancy. However, going to extremes and not eating for 48 hours during pregnancy would be entirely unsafe. Studies have shown that not eating for even 13 hours can increase the likelihood of preterm birth. Eating is more than fun and tasty.What are the disadvantages of fasting in Ramadan? ›
Some short-term side effects include headaches, dizziness, light-headedness, fatigue, low blood pressure and abnormal heart rhythms. It is argued that fasting may impair the body's ability to absorb certain medications and interfere with everyday vital bodily functions.What can cause miscarriage in early pregnancy? ›
- Exposure to TORCH diseases.
- Hormonal imbalances.
- Improper implantation of fertilized egg in your uterine lining.
- How old you are.
- Uterine abnormalities.
- Incompetent cervix (your cervix begins to open too early in pregnancy).
Not eating enough during pregnancy can lead to various issues, such as fatigue, dizziness, headaches, constipation, and an increased risk of preterm birth or low birth weight.Does fasting in Ramadan affect fertility? ›
Avoid fasting because fasting does not affect your chances of getting pregnant in a positive way but can do the opposite. However, infertile men can fast during Ramadan s fasting does neither benefit nor declines their sperm quality.Why do Muslims fast for kids? ›
Most Muslims fast between dawn and sunset. Fasting allows Muslims to devote themselves to their faith. It is thought to teach self-discipline and reminds them of the suffering of the poor. However, children, pregnant women, elderly people and those who are ill or travelling don't have to fast.What age do you stop fasting for Ramadan? ›
There is no age limit to fasting. An older healthy adult may continue to fast. However, an older person suffering from illness might not be able to fast as it may be more harmful to their health.
Traditionally, in Muslim society, women and girls are not permitted to hug or make any physical contact with male strangers, regardless of whether it is a festive occasion or not.What things can break your fast? ›
Eating, Drinking and Smoking
Fasting is the act of refraining from the basic needs of our daily life, such as eating food, drinking water and other liquids, and even smoking – which is an unpleasant habit in Islam – therefore, consuming any of these things on purpose will break your fast immediately.
Ramadan, the ninth month of the Islamic calendar, is one of the most sacred times for Muslims. During this month, Muslims observe a strict daily fast from dawn until sunset. They are not allowed to eat or drink, not even water, during these daylight hours.Can you kiss during Ramadan? ›
Kissing your partner whilst fasting does not invalidate your fast but it is advised to refrain from kissing your partner with desire during fasting hours as Muslims must abstain from food, drink and sex while fasting. You can only have sex or any intimate contact must be done before or after the hours of fasting.How long should Muslims breastfeed? ›
Abstract. PIP: Islamic law requires mothers to breast feed their children for 2 years. the father must assist the mother in breast feeding the children by providing her with food and clothing. If the father dies or does not live at home, the heir must support the mother thereby allowing her to breast feed her infants.Can I hug my wife while fasting in Ramadan? ›
If a person knows that he can control himself, then he can kiss and hug his wife even when observing an obligatory fast, but he must beware of intercourse because having intercourse (during the day) in Ramadan for one who is obliged to fast results in five things: It is a sin. The fast is invalidated.What happens to breast milk when you fast? ›
How does fasting affect the breastfeeding mother and child? Breastfeeding research tells us that short-term fasting (not eating) will not decrease milk supply, but that severe dehydration can decrease milk supply.Which Allah name to recite during pregnancy? ›
ASTAGHFIR ULLAHA RABBI WA ATUBU ILAYHI. [I seek forgiveness of Allah, my Lord Cherisher and unto Him I turn repentant.] After daily prayers say salawat 140 times, (as mentioned in the 2nd month.)Which surah is for pregnancy pain? ›
The study showed that listening to the recitation of the Surah Al-Inshirah during labor had positive effects on the women's pain, anxiety and comfort levels.Which surah is for beautiful baby? ›
Surah Yusuf (Surah 12) – for a beautiful child.
- Ask Your Doctor to Strip Your Membranes. While this sounds both nasty and invasive, it is really only asking him or her to move the amniotic fluid sac from the sides of the uterus. ...
- Walk It Off. ...
- Have Sexual Moves. ...
- Nipple Stimulation. ...
- Foods That May Help Break Your Water. ...
According to the Islamic rule, pregnant women, together with breastfeeding mothers, are exempted from the obligation to fast during Ramadan. They are permitted to postpone their fasting until after delivery or to feed one poor person for each day they do not fast.How long can a pregnant woman go without eating? ›
Don't go more than two or three hours without eating
Pregnant people often wonder how long they can go without eating. The answer is to eat at least every 3 or so hours.
A detailed examination of the fetus is done in a systematic and reproducible manner. The "Rule of Three" approach entails visualizing 3 anatomical land marks in each part or plane of section of the fetus and its environment.What is rule of 5 in pregnancy? ›
The 5-1-1 Rule: The contractions come every 5 minutes, lasting 1 minute each, for at least 1 hour. Fluids and other signs: You might notice amniotic fluid from the sac that holds the baby.What is 411 pregnancy rule? ›
According to the "411 Rule" (commonly recommended by doulas and midwives), you should go to the hospital when your contractions are coming regularly 4 minutes apart, each one lasts at least 1 minute, and they have been following this pattern for at least 1 hour.What time does water break in pregnancy? ›
Your water can break at any time — before labor begins, after contractions have started or right before delivery. Your healthcare provider may even break your water for you (amniotomy). The amount of water that comes out can look like a bucket of water spilling. Or it can be a slow trickle that goes unnoticed.What can I put in my water that won't break my fast? ›
- Purified Water. Purified water is produced by processing tap or groundwater. ...
- Spring/Mineral Water. ...
- Sparkling Water. ...
- Lemon-infused Water. ...
- Black Coffee. ...
- Plain Tea.
During Ramadan, Muslims abstain from eating any food, drinking any liquids, smoking cigarettes, and engaging in any sexual activity, from dawn to sunset. That includes taking medication (even if you swallow a pill dry, without drinking any water).Who is exempt from fasting during Ramadan? ›
In Islam, there are several excuses for not fasting Ramadan, including prepubertal children, women during their menstrual period or postnatal bleeding, travelers, pregnant or breastfeeding women who believe fasting for long hours may cause harm to either themselves or their babies, the elderly who cannot tolerate ...
Abstract. PIP: Islamic law requires mothers to breast feed their children for 2 years. the father must assist the mother in breast feeding the children by providing her with food and clothing. If the father dies or does not live at home, the heir must support the mother thereby allowing her to breast feed her infants.What happens if you don't eat 3 meals a day while pregnant? ›
“Skipping breakfast and [other] meals increases the risk of premature labor.” Without a healthy morning meal, you also may feel sick to your stomach, lightheaded and, soon, famished.What happens if I go all day without eating while pregnant? ›
Conclusions: Prolonged periods without food intake during pregnancy are associated with elevated maternal corticotropin-releasing hormone concentrations and with preterm delivery.What happens if you go too long without eating during pregnancy? ›
Going too long without eating during pregnancy can cause nausea or make it worse. If you experience continuous nausea, eat every one to two hours. Avoid greasy, high-fat foods. They are more difficult to digest.