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Pradella F, Witte P, van Ewijk R. Ramadan during pregnancy and offspring health outcomes over the life course: a systematic review and meta-analysis. Hum Reprod Update 2024:dmae026. [PMID: 39178355 DOI: 10.1093/humupd/dmae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 07/18/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND Intermittent fasting, such as during Ramadan, is prevalent among pregnant women. However, the association between Ramadan during pregnancy and offspring health along the life course has not been fully established. OBJECTIVE AND RATIONALE Fetal programming research indicates that prenatal exposures, particularly during early pregnancy, can cause long-term structural and physiological changes that adversely affect offspring health. Our objective was to systematically identify and assess the evidence regarding Ramadan during pregnancy. SEARCH METHODS A total of 31 studies were sourced from PubMed, EMBASE, Web of Science, and EconLit. Included studies evaluated outcomes in individuals with prenatal Ramadan exposure, compared to unexposed Muslim controls. Main outcomes were birth weight, gestational length, and sex ratio in newborns; height, mortality, and cognition in children; and disabilities, chronic diseases, and human capital accumulation in adults. Each study was evaluated for risk of bias. The overall quality of evidence was appraised using the GRADE system. Random-effects meta-analyses were conducted for outcomes analyzed in at least three primary studies. OUTCOMES The initial search identified 2933 articles, 1208 duplicates were deleted. There were 31 publications fulfilled the eligibility criteria for the qualitative synthesis; 22 studies were included in meta-analyses. The overall quality of the evidence was low to moderate and differed by study design and outcome. Among newborns, prenatal Ramadan exposure was not associated with birth weight (mean difference (MD) -3 g (95% CI -18 to 11; I2 = 70%) or the likelihood of prematurity (percentage point difference (PPD) 0.19 (95% CI -0.11 to 0.49; I2 = 0%)). The probability that the newborn is male was reduced (PPD -0.14 (95% CI -0.28 to -0.00; I2 = 0%)). This potentially reflects sex-specific mortality rates resulting from adverse in utero circumstances. In childhood, the exposed performed slightly poorer on cognitive tests (MD -3.10% of a standard deviation (95% CI -4.61 to -1.58; I2 = 51%)). Height among the exposed was reduced, and this pattern was already visible at ages below 5 years (height-for-age z-score MD -0.03 (95% CI -0.06 to -0.00; I2 = 76%)). A qualitative literature synthesis revealed that childhood mortality rates were increased in low-income contexts. In adulthood, the prenatally exposed had an increased likelihood of hearing disabilities (odds ratio 1.26 (95% CI 1.09 to 1.45; I2 = 32%)), while sight was not affected. Other impaired outcomes included chronic diseases or their symptoms, and indicators of human capital accumulation such as home ownership (qualitative literature synthesis). The first trimester emerged as a sensitive period for long-term impacts. WIDER IMPLICATIONS Despite the need for more high-quality studies to improve the certainty of the evidence, the synthesis of existing research demonstrates that Ramadan during pregnancy is associated with adverse offspring health effects in childhood and especially adulthood, despite an absence of observable effects at birth. Not all health effects may apply to all Muslim communities, which are diverse in backgrounds and behaviors. Notably, moderating factors like daytime activity levels and dietary habits outside fasting hours have hardly been considered. It is imperative for future research to address these aspects. REGISTRATION NUMBER PROSPERO (CRD42022325770).
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Affiliation(s)
- Fabienne Pradella
- Chair of Statistics and Econometrics, Johannes Gutenberg-University, Mainz, Germany
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Paul Witte
- Chair of Statistics and Econometrics, Johannes Gutenberg-University, Mainz, Germany
| | - Reyn van Ewijk
- Chair of Statistics and Econometrics, Johannes Gutenberg-University, Mainz, Germany
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Guilfoyle MM. Ramadan fasting in the third trimester of pregnancy and postpartum colostrum cortisol concentrations in Morocco. Am J Hum Biol 2024; 36:e24071. [PMID: 38497094 DOI: 10.1002/ajhb.24071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Breast milk cortisol concentration varies among and within lactating women, but the causes and consequences of variation are not yet fully understood. This study investigated whether maternal fasting from food and water for over 16 h per day during the third trimester of pregnancy was associated with increased concentrations of cortisol in colostrum during the month of Ramadan in a Moroccan sample. Participants were women who gave birth at the public maternity hospital in Rabat, Morocco throughout the month of and month following Ramadan. Participants completed interviews (N = 92), underwent anthropometric assessment (N = 73), and colostrum samples (N = 63) were collected approximately 48-72 h postpartum. Cortisol analysis was completed on a subset of colostrum samples (N = 43). Women were categorized as fasting every day of Ramadan before giving birth (N = 52/92, 57%), fasting some days (N = 29/92, 32%), and not fasting (N = 11/92, 11%). For women who fasted, average fasting duration was 19.5 days (range: 1-29 days), and average time between the last day of fasting and birth was 8.8 days (range: 0-43 days). The number of days of fasting was positively associated with cortisol concentrations in colostrum (p < .009) in a multivariate analysis controlling for maternal anthropometry, hypertension and/or diabetes, and reasons for opting out of fasting. Each day of fasting was associated with a 4.05% increase in colostrum cortisol. Results are consistent with the hypothesis that maternal fasting during the third trimester of pregnancy increases breast milk cortisol and thus alters the hormonal milieu to which the infant is exposed.
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Noghanibehambari H, Fletcher J, Schmitz L, Duque V, Gawai V. Early-Life Economic Conditions and Old-Age Male Mortality: Evidence from Historical County-Level Bank Deposit Data. JOURNAL OF POPULATION ECONOMICS 2024; 37:32. [PMID: 39301052 PMCID: PMC11411638 DOI: 10.1007/s00148-024-01007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/01/2024] [Indexed: 09/22/2024]
Abstract
This paper studies the long-run mortality effects of in-utero and early-life economic conditions. We examine how local economic conditions experienced during the Great Depression, proxied by county-level banking deposits during in-utero and first years of life, influence old-age longevity. We find that a one-standard-deviation rise in per capita bank deposits is associated with an approximately 1.7 month increase in males' longevity at old age. Additional analyses comparing state-level versus county-level economic measures provide insight on the importance of controlling for local-level confounders and exploiting more granular measures when exploring the relationship between early-life conditions and later-life mortality.
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Affiliation(s)
- Hamid Noghanibehambari
- College of Business, Austin Peay State University, Marion St, Clarksville, TN 37040, USA
| | - Jason Fletcher
- La Follette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI 53706-1211, USA
| | - Lauren Schmitz
- La Follette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI 53706-1211, USA
| | - Valentina Duque
- Department of Economics, University of Sydney, FASS Building A02, Room 564 University of Sydney, NSW, 2006, Australia
| | - Vikas Gawai
- Department of Agricultural & Applied Economics, University of Wisconsin-Madison, 305 Taylor Hall, 427 Larch St., Madison, WI 53706, USA
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AbuShihab K, Obaideen K, Alameddine M, Alkurd RAF, Khraiwesh HM, Mohammad Y, Abdelrahim DN, Madkour MI, Faris ME. Reflection on Ramadan Fasting Research Related to Sustainable Development Goal 3 (Good Health and Well-Being): A Bibliometric Analysis. JOURNAL OF RELIGION AND HEALTH 2023:10.1007/s10943-023-01955-9. [PMID: 38110843 DOI: 10.1007/s10943-023-01955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
There is a large body of research on Ramadan intermittent fasting (RIF) and health in Muslim communities, that can offer insights to promote the achievement of Sustainable Development Goal 3 (SDG 3), which encompasses good health and well-being. Based on recent bibliometric evidence, we hypothesized that RIF research is highly relevant to SDG 3, particularly Targets 3.1, 3.2, 3.4, and 3.5. Therefore, this bibliometric study quantified RIF literature supporting SDG 3 and associated targets over the past seven decades and explored themes and trends. All types of research articles were extracted from the Scopus database from inception to March 2022. Microsoft Excel, Biblioshiny, and VOSviewer were used to qualitatively and quantitatively examine RIF research trends supporting SDG 3 and associated targets. We identified 1729 relevant articles. The number of publications notably increased since 1986, with a dramatic increase in 2019-2020. RIF research predominantly supported Target 3.4 (reducing risk for non-communicable diseases), with research hotspots being diabetes, diabetes medications, pregnancy, physiology, metabolic diseases, and obesity and metabolism. This target was also the most commonly supported by dedicated authors and institutions publishing on RIF, whereas other SDG 3 targets were negligibly addressed in comparison. Our comprehensive bibliometric analysis of RIF literature showed growing support for SDG 3 through positive contributions to half of the SDG 3 targets, although Target 3.4 received the most attention. We also identified knowledge gaps that may shape further research directions on RIF and promote the achievement of SDG 3 in Muslim communities.
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Affiliation(s)
- Katia AbuShihab
- Nutrition and Food Research Group, Research Institute of Medical and Health Sciences (RIMHS), Sharjah University, Sharjah, United Arab Emirates
| | - Khaled Obaideen
- Sustainable Engineering Asset Management Research Group, University of Sharjah, Sharjah, United Arab Emirates.
| | - Mohamad Alameddine
- Department of Health Service Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Refat Ahmad Fawzi Alkurd
- Faculty of Pharmacy and Medical Sciences, Department of Nutrition, University of Petra, Amman, Jordan
| | - Husam M Khraiwesh
- Department of Nutrition and Food Processing, Faculty of Agricultural Technology, Al-Balqa' Applied University, Salt, Jordan
| | - Yara Mohammad
- College of Engineering and Information Technology, Ajman University, Ajman, United Arab Emirates
| | - Dana N Abdelrahim
- Health Promotion Research Group, Research Institute of Medical and Health Sciences (RIMHS), Sharjah University, Sharjah, United Arab Emirates
| | - Mohamed I Madkour
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - MoezAlIslam E Faris
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates.
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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Ramadan during pregnancy and neonatal health-Fasting, dietary composition and sleep patterns. PLoS One 2023; 18:e0281051. [PMID: 36791059 PMCID: PMC9931121 DOI: 10.1371/journal.pone.0281051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Large shares of pregnant Muslims worldwide observe the Ramadan fast. Previous research showed that Ramadan during pregnancy is associated with adverse offspring health outcomes lasting throughout the life-course. Evidence on effects on birth outcomes is inconclusive, however, and previous research did not consider the role of dietary composition and sleep patterns during Ramadan. This study systematically documents maternal lifestyle during Ramadan and assesses if diet and sleep adaptations to Ramadan, independent of and in addition to maternal fasting, are associated with neonatal health outcomes. METHODS This study reports a survey of 326 Muslims who delivered their baby in Mainz, Germany, linked to maternal & infant hospital records. Participants reported on fasting, dietary composition and sleep schedules while pregnant during Ramadan. RESULTS Fasting during pregnancy was associated with reduced birthweight, in particular for fasting during the first trimester (-352ˑ92g, 95% CI: -537ˑ38; -168ˑ46). Neither dietary composition nor altered sleep were directly associated with birthweight. However, dietary composition during Ramadan outside of fasting hours seems to moderate the fasting-birthweight association, which disappeared for women switching to high-fat diets. CONCLUSIONS The finding that dietary intake during Ramadan potentially moderates the fasting-birthweight association is of high relevance to pregnant Muslims who wish to fast and their healthcare professionals, since dietary choices outside of fasting hours are often relatively easily modifiable. This is the first study to include information on maternal diet and sleep during Ramadan, and additional research is needed to assess the roles of specific (macro)nutrients and food groups.
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Viinikainen J, Bryson A, Böckerman P, Kari JT, Lehtimäki T, Raitakari O, Viikari J, Pehkonen J. Does better education mitigate risky health behavior? A mendelian randomization study. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101134. [PMID: 35354116 DOI: 10.1016/j.ehb.2022.101134] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Education and risky health behaviors are strongly negatively correlated. Education may affect health behaviors by enabling healthier choices through higher disposable income, increasing information about the harmful effects of risky health behaviors, or altering time preferences. Alternatively, the observed negative correlation may stem from reverse causality or unobserved confounders. Based on the data from the Cardiovascular Risk in Young Finns Study linked to register-based information on educational attainment and family background, this paper identifies the causal effect of education on risky health behaviors. To examine causal effects, we used a genetic score as an instrument for years of education. We found that individuals with higher education allocated more attention to healthy habits. In terms of health behaviors, highly educated people were less likely to smoke. Some model specifications also indicated that the highly educated consumed more fruit and vegetables, but the results were imprecise in this regard. No causal effect was found between education and abusive drinking. In brief, inference based on genetic instruments showed that higher education leads to better choices in some but not all dimensions of health behaviors.
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Affiliation(s)
- Jutta Viinikainen
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland.
| | - Alex Bryson
- University College London, Social Research Institute, London, United Kingdom; National Institute of Economic and Social Research, London, United Kingdom; IZA Institute of Labor Economics, Bonn, Germany
| | - Petri Böckerman
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland; IZA Institute of Labor Economics, Bonn, Germany; Labour Institute for Economic Research LABORE, Helsinki, Finland
| | - Jaana T Kari
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland
| | - Terho Lehtimäki
- Tampere University, Department of Clinical Chemistry, Tampere, Finland; Fimlab Laboratories, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland
| | - Olli Raitakari
- University of Turku and Turku University Hospital, Centre for Population Health Research, Turku, Finland; University of Turku, Research Centre of Applied and Preventive Cardiovascular Medicine, Turku, Finland; Turku University Hospital, Department of Clinical Physiology and Nuclear Medicine, Turku, Finland
| | - Jorma Viikari
- University of Turku, Department of Medicine, Turku, Finland; Turku University Hospital, Division of Medicine, Turku, Finland
| | - Jaakko Pehkonen
- University of Jyväskylä, Jyväskylä University School of Business and Economics, Jyväskylä, Finland
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Werner LK, Ludwig JO, Sie A, Bagagnan CH, Zabré P, Vandormael A, Harling G, De Neve JW, Fink G. Health and economic benefits of secondary education in the context of poverty: Evidence from Burkina Faso. PLoS One 2022; 17:e0270246. [PMID: 35793332 PMCID: PMC9258827 DOI: 10.1371/journal.pone.0270246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Even though formal education is considered a key determinant of individual well-being globally, enrollment in secondary schooling remains low in many low- and middle-income countries, suggesting that the perceived returns to such schooling may be low. We jointly estimate survival and monetary benefits of secondary schooling using detailed demographic and surveillance data from the Boucle du Mouhoun region, Burkina Faso, where national upper secondary schooling completion rates are among the lowest globally (<10%). We first explore surveillance data from the Nouna Health and Demographic Surveillance System from 1992 to 2016 to determine long-term differences in survival outcomes between secondary and higher and primary schooling using Cox proportional hazards models. To estimate average increases in asset holdings associated with secondary schooling, we use regionally representative data from the Burkina Faso Demographic Health Surveys (2003, 2010, 2014, 2017–18; N = 3,924). Survival was tracked for 14,892 individuals. Each year of schooling was associated with a mortality reduction of up to 16% (95% CI 0.75–0.94), implying an additional 1.9 years of life expectancy for men and 5.1 years for women for secondary schooling compared to individuals completing only primary school. Relative to individuals with primary education, individuals with secondary or higher education held 26% more assets (SE 0.02; CI 0.22–0.30). Economic returns for women were 3% points higher than male returns with 10% (SE 0.03; CI 0.04–0.16) vs. 7% (SE 0.02; CI 0.02–0.012) and in rural areas 20% points higher than in urban areas with 30% (SE 0.06; CI 0.19–0.41) vs. 4% (SE 0.01; CI 0.02–0.07). Our results suggest that secondary education is associated with substantial health and economic benefits in the study area and should therefore be considered by researchers, governments, and other major stakeholders to create for example school promotion programs.
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Affiliation(s)
- Luisa K. Werner
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Medical Faculty and University Hospital, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
- * E-mail:
| | - Jan-Ole Ludwig
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Ali Sie
- Health Research Centre of Nouna, Ministry of Health, Nouna, Kossi Province, Boucle du Mouhoun Region, Burkina Faso
| | - Cheik H. Bagagnan
- Health Research Centre of Nouna, Ministry of Health, Nouna, Kossi Province, Boucle du Mouhoun Region, Burkina Faso
| | - Pascal Zabré
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Health Research Centre of Nouna, Ministry of Health, Nouna, Kossi Province, Boucle du Mouhoun Region, Burkina Faso
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Guy Harling
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America
- Africa Health Research Institute, Congella, Durban, South Africa
- Institute for Global Health, University College London, Royal Free Hospital, London, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Agincourt, Bushbuckridge Local Municpality, Johannesburg, South Africa
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Basel-Stadt, Switzerland
- University of Basel, Basel, Basel-Stadt, Switzerland
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Mahanani MR, Abderbwih E, Wendt AS, Deckert A, Antia K, Horstick O, Dambach P, Kohler S, Winkler V. Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review. Nutrients 2021; 13:nu13124511. [PMID: 34960063 PMCID: PMC8704584 DOI: 10.3390/nu13124511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022] Open
Abstract
Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.
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Affiliation(s)
- Melani R. Mahanani
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Eman Abderbwih
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Amanda S. Wendt
- Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, P.O. Box 601203, 14412 Potsdam, Germany;
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Khatia Antia
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Olaf Horstick
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Peter Dambach
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
| | - Volker Winkler
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.R.M.); (E.A.); (A.D.); (K.A.); (O.H.); (P.D.); (S.K.)
- Correspondence: ; Tel.: +49-6221-56-5031
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Bernier J, Bilodeau-Bertrand M, Djeha A, Auger N. Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada. Paediatr Perinat Epidemiol 2021; 35:689-693. [PMID: 34080705 DOI: 10.1111/ppe.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data on fasting during Ramadan and the risk of preterm birth and child mortality are conflicting, but the association with stillbirth is unknown. OBJECTIVE We studied the relationship between Ramadan and the risk of stillbirth for Arab women in Quebec, Canada. METHODS We conducted a retrospective cohort study using birth certificates for Arab women in Quebec, Canada, between 1981 and 2017. The exposure was Ramadan in the first and second trimester (1-27 weeks of gestation), and the outcome was early (<28 weeks) or late (≥28 weeks) stillbirth. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association between Ramadan and risk of stillbirth. We adjusted models for maternal characteristics and assessed associations by cause of death. RESULTS The study included 78,349 live births and 274 stillbirths. There were 3.5 stillbirths per 1,000 pregnancies for women exposed to Ramadan between weeks 1-27 of gestation (95% CI 3.0, 4.0), and 3.4 per 1,000 for unexposed women (95% CI 2.8, 4.1). Compared with no exposure, Ramadan between weeks 1-27 was not associated with the risk of early (RR 1.32, 95% CI 0.76, 2.28) or late stillbirth (RR 0.93, 95% CI 0.70, 1.23) in adjusted models. RRs for early stillbirth were 1.40 for Ramadan between weeks 15-21 (95% CI 0.70, 2.80) and 1.38 for Ramadan between weeks 22-27 (95% CI 0.67, 2.84). Relative to no exposure, Ramadan between weeks 15-21 was associated with early stillbirth due to congenital anomaly (RR 3.96; 95% CI 1.35, 11.57) in unadjusted models. There was no association with other causes of stillbirth. CONCLUSIONS There is no evidence that Ramadan is associated with the risk of early or late stillbirth overall. Further research is needed to confirm an association with stillbirth due to congenital anomalies.
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Affiliation(s)
- Julie Bernier
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | | | - Améyo Djeha
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review. Nutrients 2021; 13:nu13103450. [PMID: 34684451 PMCID: PMC8540108 DOI: 10.3390/nu13103450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Ramadan is one of the five pillars of Islam, during which fasting is obligatory for all healthy individuals. Although pregnant women are exempt from this Islamic law, the majority nevertheless choose to fast. This review aims to identify the effects of Ramadan fasting on the offspring of Muslim mothers, particularly on fetal growth, birth indices, cognitive effects and long-term effects. A systematic literature search was conducted until March 2020 in Web of Science, Pubmed, Cochrane Library, Embase and Google Scholar. Studies were evaluated based on a pre-defined quality score ranging from 0 (low quality) to 10 (high quality), and 43 articles were included. The study quality ranged from 2 to 9 with a mean quality score of 5.4. Only 3 studies had a high quality score (>7), of which one found a lower birth weight among fasting women. Few medium quality studies found a significant negative effect on fetal growth or birth indices. The quality of articles that investigated cognitive and long-term effects was poor. The association between Ramadan fasting and health outcomes of offspring is not supported by strong evidence. To further elucidate the effects of Ramadan fasting, larger prospective and retrospective studies with novel designs are needed.
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Placek CD, Jaykrishna P, Srinivas V, Madhivanan P. Pregnancy Fasting in Ramadan: Toward a Biocultural Framework. Ecol Food Nutr 2021; 60:785-809. [PMID: 33890529 DOI: 10.1080/03670244.2021.1913584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pregnancy fasting poses a paradox: why would a woman restrict her diet during a period of increased nutritional need? This qualitative, cross-sectional study applied biological and cultural evolutionary theories of pregnancy diet to emic models of fasting with the aim of establishing a testable biocultural framework of pregnancy fasting. The research took place with Muslim women residing in Mysore, India. In-depth interviews were conducted with pregnant women who have experience and knowledge of fasting during during the holy month of Ramadan. Our findings indicate that pregnancy fasting is socially acquired via multiple modes of transmission and that women do not fast according to mainstream evolutionary theories of pregnancy diet, but perhaps to gain moral capital.
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Affiliation(s)
- Caitlyn D Placek
- Department of Anthropology, Ball State University, Muncie, Indiana, USA
| | | | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India.,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health University of Arizona, Tucson, Arizona, USA.,Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, Arizona, USA.,University of Arizona, Tucson, Arizona, USA
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12
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Hassanein M, Abuelkheir S, Alsayyah F, Twair M, Abdelgadir E, Basheir A, Rashid F, Al Saeed M, Eltayb F, Abdellatif M, Khalifa A, Alawadi F. Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting. Diabetes Res Clin Pract 2021; 173:108669. [PMID: 33460717 DOI: 10.1016/j.diabres.2021.108669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022]
Abstract
AIMS There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability. METHODS 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment. RESULTS The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min. CONCLUSION Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates.
| | - Sona Abuelkheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatima Alsayyah
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Manal Twair
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Elamin Abdelgadir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Alaaeldin Basheir
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fauzia Rashid
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Maryam Al Saeed
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fawzi Eltayb
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Mohammed Abdellatif
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Azza Khalifa
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
| | - Fatheya Alawadi
- Endocrine Department, Dubai Hospital, Dubai Health Authority, Alkhaleej Road, P.O. Box 7272, Dubai, United Arab Emirates
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Seiermann AU, Al-Mufti H, Waid JL, Wendt AS, Sobhan S, Gabrysch S. Women's fasting habits and dietary diversity during Ramadan in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2021; 17:e13135. [PMID: 33522117 PMCID: PMC8189200 DOI: 10.1111/mcn.13135] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 01/01/2023]
Abstract
Little is known about fasting practices and dietary changes during Ramadan in low‐ and lower‐middle‐income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community‐based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD‐W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control. During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD‐W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non‐fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non‐fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later‐life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.
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Affiliation(s)
- Andrea U Seiermann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hudaalrahman Al-Mufti
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Nineveh Directorate of Health, Ministry of Health, Nineveh, Iraq
| | - Jillian L Waid
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Amanda S Wendt
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany
| | - Shafinaz Sobhan
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Gabrysch
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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14
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Viinikainen J, Bryson A, Böckerman P, Elovainio M, Hutri-Kähönen N, Juonala M, Lehtimäki T, Pahkala K, Rovio S, Pulkki-Råback L, Raitakari O, Pehkonen J. Do childhood infections affect labour market outcomes in adulthood and, if so, how? ECONOMICS AND HUMAN BIOLOGY 2020; 37:100857. [PMID: 32078928 DOI: 10.1016/j.ehb.2020.100857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
A burgeoning body of literature suggests that poor childhood health leads to adverse health outcomes, lower educational attainment and weaker labour market outcomes in adulthood. We focus on an important but under-researched topic, which is the role played by infection-related hospitalization (IRH) in childhood and its links to labour market outcomes later in life. The participants aged 24-30 years in 2001 N = 1706 were drawn from the Young Finns Study, which includes comprehensive registry data on IRHs in childhood at ages 0-18 years. These data are linked to longitudinal registry information on labour market outcomes (2001-2012) and parental background (1980). The estimations were performed using ordinary least squares (OLS). The results showed that having an additional IRH is associated with lower log earnings (b = -0.110, 95 % confidence interval (CI): -0.193; -0.026), fewer years of being employed (b = -0.018, 95 % CI: -0.031; -0.005), a higher probability of receiving any social income transfers (b = 0.012, 95 % CI: -0.002; 0.026) and larger social income transfers, conditional on receiving any (b = 0.085, 95 % CI: 0.025; 0.145). IRHs are negatively linked to human capital accumulation, which explains a considerable part of the observed associations between IRHs and labour market outcomes. We did not find support for the hypothesis that adult health mediates the link.
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Affiliation(s)
- Jutta Viinikainen
- Jyväskylä University School of Business and Economics, P.O.Box 35, FI-40014, Jyväskylä, Finland.
| | - Alex Bryson
- University College London, NIESR, London, United Kingdom and IZA, Bonn, Germany.
| | - Petri Böckerman
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland; Labour Institute for Economic Research, Helsinki, Finland and IZA, Bonn, Germany.
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland and National Institute for Health and Welfare, Helsinki, Finland.
| | - Nina Hutri-Kähönen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland, Division of Medicine, Turku University Hospital, Turku, Finland, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere University, Tampere, Finland.
| | - Katja Pahkala
- Research Centre for Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland, Sports & Exercise Medicine Unit, Department of Physical Activity and Health, Paavo Nurmi Centre, Turku, Finland.
| | - Suvi Rovio
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki,Finland.
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.
| | - Jaakko Pehkonen
- Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland.
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15
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Ramadan exposure and birth outcomes: a population-based study from the Netherlands. J Dev Orig Health Dis 2019; 11:664-671. [PMID: 31822318 DOI: 10.1017/s2040174419000837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ramadan, the Islamic month of daytime fasting, is observed by many pregnant Muslims. Although pregnant women are exempt, many prefer to fast. Previous research has shown long-term adverse effects on various health outcomes among the offspring, but evidence on effects on perinatal outcomes is mixed. This study investigates effects of Ramadan during pregnancy among Muslims in the Netherlands. METHODS Data from the Perinatal Registry of the Netherlands (Perined) on all births between 2000 and 2010 to mothers recorded as Mediterranean (i.e. of Turkish/Moroccan descent, a proxy for Muslim) (n = 139,322) or as ethnically Dutch (n = 1,481,435) were used. Ramadan exposure was defined using an intention-to-treat approach as the occurrence of a Ramadan during gestation. Muslims with versus without a Ramadan occurring during gestation were compared using difference-in-differences analyses. In these multiple linear/logistic regressions, non-Muslims were additionally included in order to take out potentially remaining confounding through seasonal effects. RESULTS The occurrence of a Ramadan during pregnancy among Muslims was not associated with altered birth weight, gestational length, newborn's sex, perinatal mortality, low Apgar, or mild congenital anomalies. Odds for severe congenital anomalies were higher among the exposed (odds ratio: 1.17; 95% confidence interval: 1.00, 1.37), but this association became non-significant when adjusting for multiple testing. CONCLUSIONS Despite earlier research showing long-term adverse health effects of prenatal exposure to Ramadan, there seems to be little or no relation between exposure to Ramadan during pregnancy and birth outcomes.
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16
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Tith RM, Bilodeau-Bertrand M, Lee GE, Healy-Profitós J, Auger N. Fasting during Ramadan Increases Risk of Very Preterm Birth among Arabic-Speaking Women. J Nutr 2019; 149:1826-1832. [PMID: 31198942 DOI: 10.1093/jn/nxz126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 05/15/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The impact of fasting on risk of preterm birth during Ramadan is unclear. OBJECTIVES We evaluated the association between Ramadan fasting during pregnancy and risk of preterm birth for Arab women in Canada. METHODS We analyzed birth certificates from 3,123,508 deliveries in Quebec, Canada, from 1981 to 2017. We identified 78,109 births of Arabic-speaking women and determined if Ramadan occurred during any trimester of pregnancy. We calculated rates of extreme (22-27 wk), very (28-31 wk), and late (32-36 wk) preterm birth and estimated RRs and 95% CIs for the association of Ramadan fasting with risk of preterm birth by pregnancy trimester, using log-binomial regression models adjusted for maternal characteristics. RESULTS Arabic speakers had an overall preterm birth rate of 5.53 per 100 births, but rates varied with timing of Ramadan. Among Arabic speakers, fasting during Ramadan between weeks 15-21 of the second trimester was associated with 1.33 times the risk of very preterm birth relative to no fasting (95% CI: 1.06, 1.68). Between weeks 22 and 27 of the second trimester, fasting during Ramadan was associated with 1.53 times the risk of very preterm birth (95% CI: 1.21, 1.93). Ramadan fasting was not associated with extreme or late preterm birth regardless of the trimester of pregnancy. CONCLUSIONS In this study of 78,109 births to Arabic-speaking women in Quebec, Ramadan fasting during the second pregnancy trimester was associated with the risk of very preterm birth. Optimal prenatal education about nutritional needs in the second trimester of pregnancy is recommended.
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Affiliation(s)
- Rasmi M Tith
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Institut National de Santé Publique du Québec, Montreal, Quebec, Canada
| | | | - Ga Eun Lee
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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17
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Kunto YS, Mandemakers JJ. The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: Evidence from the Indonesian Family Life Survey. ECONOMICS AND HUMAN BIOLOGY 2019; 33:29-39. [PMID: 30658271 DOI: 10.1016/j.ehb.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 06/09/2023]
Abstract
Many pregnant Muslim women fast during the Muslim holy month of Ramadan. A number of studies have reported negative life outcomes in adulthood for children who were prenatally exposed to Ramadan. However, other studies document minimal to no impact on neonatal indicators. Using data from the Indonesian Family Life Survey consisting of 45,246 observations of 21,723 children born to 9771 mothers, we contribute to the current discussion on prenatal exposure to Ramadan by examining the effects on stature (height-for-age Z-scores, weight-for-age Z-scores, and body-mass-index-for-age Z-scores: HAZ, WAZ, and BAZ, respectively) from early childhood to late adolescence (0-19 years of age). We introduce an objective mother's religiosity indicator to improve the intention-to-treat estimations. Children were classified into three groups based on their mother's religion-religiosity: religious Muslims, less-religious Muslims, and non-Muslims. Using cluster-robust mother fixed-effects, we found negative effects on stature for children born to religious Muslim mothers. The effects were age-dependent and timing-sensitive. For example, children born to religious Muslim mothers were shorter in late adolescence (15-19 years of age) compared to their unexposed siblings if they were prenatally exposed in the first trimester of pregnancy (HAZ difference = -0.105 SD; p-val. <0.05). Interestingly, we found positive effects on stature for exposed less-religious Muslim children that peak in early adolescence (10-14 years of age) and negative effects on stature for exposed non-Muslim children that occur only in early childhood (0-4 years of age). We nuance our discussion of health and socioeconomic factors to explain these surprising results.
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Affiliation(s)
- Yohanes Sondang Kunto
- Wageningen School of Social Sciences, Wageningen University & Research, the Netherlands; Faculty of Economics, Petra Christian University, Indonesia.
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18
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Beshyah S, Badi A, El-Ghul A, Gabroun A, Dougman K, Eledrisi M. The Year in “Ramadan Fasting and Health” (2018): A Narrative Review. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2019. [DOI: 10.4103/ijmbs.ijmbs_77_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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19
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Lakhdar A. The Year in Ramadan Fasting and Health: Changing Perspectives and a Slow Pace! IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2019. [DOI: 10.4103/ijmbs.ijmbs_81_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Abstract
Neonatal abstinence syndrome refers to the signs and symptoms attributed to the cessation of prenatal exposure (via placental transfer) to various substances. This Primer focuses on neonatal abstinence syndrome caused by opioid use during pregnancy - neonatal opioid withdrawal syndrome (NOWS). As the global prevalence of opioid use has alarmingly increased, so has the incidence of NOWS. NOWS can manifest with varying severity or not at all, for unknown reasons, but is likely to be associated with multiple factors, both maternal (for example, smoking and additional substance exposures) and neonatal (gestational age, sex and genetics). Care for the infant with NOWS begins with addressing the issues experienced by pregnant women with opioid use disorder. Co-occurring mental illness, economic hardship, intimate partner violence, infectious diseases and limited access to care are common in these women and can result in poor maternal and neonatal outcomes. Although there is no consensus regarding optimal NOWS management, non-pharmacological interventions (such as breastfeeding and rooming-in of the mother and the baby) have become a priority, as they can ameliorate symptoms without the need for further opioid exposure. Untreated NOWS can be associated with morbidity in early infancy, and the long-term consequences of fetal opioid exposure are only beginning to be understood.
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Affiliation(s)
- Mara G Coyle
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Susan B Brogly
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - Mahmoud S Ahmed
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Stephen W Patrick
- Vanderbilt Center for Child Health Policy, Department of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina, Carrboro, NC, USA
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21
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Gabrysch S, van Ewijk R. Gabrysch and van Ewijk Respond to "Detrimental Consequences of Adverse Early-Life Conditions" and "Ramadan, Pregnancy, Nutrition, and Epidemiology". Am J Epidemiol 2018; 187:2098-2099. [PMID: 29741572 DOI: 10.1093/aje/kwy090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabine Gabrysch
- Unit of Epidemiology and Biostatistics, Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Reyn van Ewijk
- Gutenberg School of Management and Economics, Johannes Gutenberg University, Mainz, Germany
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22
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Stein AD. Invited Commentary: Ramadan, Pregnancy, Nutrition, and Epidemiology. Am J Epidemiol 2018; 187:2095-2097. [PMID: 29741561 DOI: 10.1093/aje/kwy089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 11/13/2022] Open
Abstract
Ramadan is observed by 1.6 billion Muslims. In an accompanying article that uses data from the Nouna Health and Demographic Surveillance System in Burkina Faso, Schoeps et al. (Am J Epidemiol. 2018;187(10):2085-2092) find that exposure to Ramadan in early pregnancy is associated with an increased risk of mortality among children under age 5 years. Ramadan exposes observant individuals to a specific pattern of nutrition and other behaviors, including changes in sleep patterns. How these behaviors might result in child mortality is not yet understood, and the findings reported in this paper should be replicated in other settings.
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Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Heath, Emory University, Atlanta, Georgia
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