Abstract

This study aimed to evaluate the association between Ramadan fasting during pregnancy and maternal and neonatal outcomes in a large multicenter cohort. A retrospective cohort study including 13,709 singleton deliveries at three state hospitals in Türkiye. Women were classified as fasting (n = 2,166; 15.8%) or non-fasting (n = 11,543; 84.2%) during Ramadan based on antenatal records. Primary outcomes were preterm birth, birthweight, and small for gestational age (SGA). Secondary outcomes included cesarean delivery, gestational age at delivery, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), 5-minute Apgar score, and neonatal intensive care unit (NICU) admission. Multivariable regression models were adjusted for maternal age, body mass index (BMI), parity, smoking, chronic disease, and trimester of Ramadan exposure. Baseline characteristics were largely comparable between groups. Fasting women had higher rates of GDM (5.4% vs. 5.1%) and HDP (3.9% vs. 3.2%) and a higher cesarean delivery rate (51.4% vs. 48.2%). Mean gestational age at delivery was marginally lower in the fasting group (38.1 ± 1.6 vs. 38.3 ± 1.7 weeks). No significant differences were found in preterm birth, very preterm birth, SGA, or NICU admission. After multivariable adjustment, Ramadan fasting remained associated with GDM (adjusted OR: 1.06; 95% CI: 1.01 – 1.12) and HDP (adjusted OR: 1.12; 95% CI: 1.01 – 1.25). After adjustment, fasting was not associated with cesarean delivery (adjusted OR: 1.08; 95% CI: 0.98 – 1.19), but remained associated with low 5-minute Apgar score (< 7) (adjusted OR: 1.52; 95% CI: 1.08 – 2.14). The apparent increase in birthweight seen in unadjusted analysis was not sustained after adjustment. Ramadan fasting during pregnancy was not associated with most major adverse perinatal outcomes after adjustment for confounders. However, the associations with GDM and HDP were modest, and the association with low 5-minute Apgar score was based on a small number of events; these findings should be interpreted cautiously and do not establish causality. Individualized counseling and clinical monitoring are recommended, particularly for women with metabolic or vascular risk factors.

Key words: Ramadan, fasting, gestational diabetes mellitus, hypertensive disorders of pregnancy, perinatal outcomes, cesarean delivery