Effects of short-term maternal fasting in the third trimester of pregnancy on fetal biophysical profile and Doppler indices scores

Physicians' attitudes and views regarding religious fasting during pregnancy and review of the literature

Many patients worldwide seek medical advice regarding safety of fasting during pregnancy. This issue lacks high quality evidence, which makes giving medical advice challenging. To aid decision making on this subject we performed an internet mediated survey to determine the expert opinion on this issue. The survey was answered by one hundred and eight obstetricians and gynecologists (OB/GYN). The questions were aimed at the content of the medical advice given to pregnant patients on Ramadan (for Muslim patients) and Yom Kippur (for Jewish patients) fasts. For both fasts, most physicians recommended against fasting on the second or third trimester, while fasting on the first trimester was controversial. Differences were found between medical advices provided by physicians according to their demographical characteristics. Regarding Ramadan fast, senior specialists were more lenient about fasting than younger specialists (62% and 35%, respectively, p = 0.01). As to Yom Kippur fast, religious and traditional physicians were more likely to permit fasting compared to their secular colleagues (53% and 25%, respectively, p = 0.01). Additionally, a comprehensive literature review was conducted revealing possible adverse maternal and fetal outcomes of fasting; however the risk for long term clinical complications is yet to be defined.

Does diurnal rhythm have an impact on fetal biophysical profile?

OBJECTIVES

To investigate whether parameters in fetal biophysical profile (BPP) testing exhibit a diurnal rhythm and to discuss the probable factors associated with these variables.

METHODS

Thirty healthy primigravid patients carrying pregnancies between 35 and 40 completed weeks were enrolled for the study. Fetal BPP testing was performed for each patient both in the early morning (08:00-10:00 am) and in the late evening (08:00-10:00 pm), and the scoring parameters were compared between morning and evening tests.

RESULTS

BPP scores in the evening were significantly higher than that in the morning (p < 0.05). Deepest vertical amniotic pocket measurements and fetal breathing absence in the morning mostly contributed to this variation (p < 0.001). Fetal movement counts were also significantly lower in the morning tests (p < 0.001).

CONCLUSIONS

The parameters of BPP exhibit circadian variations in healthy fetuses, which may be associated with many factors such as fetomaternal hormones. It is essential for the clinician to be aware of these changes when interpreting the results, as interventions based on false-positive results may have deleterious effects on both the mother and her fetus.