The existing literature mainly focuses onthe impact of the fasting mother during pregnancy on nutritional level, healthoutcomes and weight change in a child. Although fasting during Ramadan is a universal phenomenon for Muslimsall over the world, however these studies represent mixed results due todifferent cultural, geographical conditions and income levels in differentcountries. Some of the studies from existing literature have been reviewed.

A number of studies have found the adverseeffects of maternal fasting on fetal health, fetal breathing and fetal heartrates.Almond and Mozmudar, 2011 used holy monthof Ramadan as a natural experiment to analyses the fetal health during fasting.In case of Michigan sample 1989-2006 for Arab Muslim parents, they found lowerbirth weights and reduction of male offspring if Ramadan overlapped with firstgestation month. A strong positive association was found between utero exposureto Ramadan and disability at an adult age, especially mental or learningdisabilities in Uganda Census 2002 and Iraq Census 1997.

In addition, they foundpositive effects wealth, earnings and composition of adult age. No evidence wasfound for negative selection in conception during Ramadan. In another study of Almond, Chay, and Lee,2005Attitude towards the male offspring isdepend on the sensitivity of maternal health Trivers and Willard, 1973.

It can be safely concluded in the light of the abovestudies that fasting during early stages of pregnancy has a negative effect onfetal health. A study to determine relationship between   fasting during pregnancy and birth weight relationshipwas conducted in Iran for a sample of forty-three hundred women by The samplewas divided into four groups that is fasting, non-fasting group. They did notfind any kind of significant impact on birth weight of infant in fixed no ofdays fasting and non-fasting group, other than second trimester withinsignificant results. They also said to do fast in first trimester was more incomparison of other trimester. Arab and Nasrollahi, 2001.To find the long-term effect of fasting duringpregnancy there is one study conducted in between 191 children under age 4 to13 years from 15 Islamic primary schools of Iraq, consider 98 children in atreatment group whose mothers they did fast and other are control group, they didnot do any fas0 t. They didn’t found any kind of significant differences inbetween of age, sex and IQ scores of two groups Azizi et al. 2004.

Cohen and Kim, 2009 used aggregated data from theBehavioral Risk Factor Surveillance System (BRFSS) with special moduleregarding weight loss. To reduce weight during pregnancy is a high risk forboth mother and baby, evidence found that tendency to reduce weight is higherin the age group of 35-44 years, most probably the pregnancy is unwanted andthey are unaware about her conception.Some studies have also come up with the results whereRamadan fasting has been found to be associated with the increase in cortisollevel in healthy pregnant women with pregnancy duration of around 20 weeks, mostprobably the reason is rich carbohydrate food people like to consumed duringfasting Dikensoy et al. 2009. The cristols a stresshormone frequently raised as a potential mechanism through which prenatalexperiences may “program” adult health Kapoor et al.

, 2006.Franko et al, 2009 said about 20 million of the childrenwere born as low birth weight in developing countries as a main reason of childmortality or many other infective illness. Oxygen and glucose supply duringearly pregnancy period is so essential for embryonic development and “poormalnutrition at this stage produces offspring’s with higher blood pressure”Gluckmanand Hanson, 2005.In another study 284 of neonates of the mother with ahistory of fasting during Ramadan were compared with 255 neonates of themothers who did not faced Ramadan during pregnancy. The univariate analysisshowed that weights of the children born to the mothers with fasting historywere more than the weights of the children born to the non-fasting mothers withsignificant probabilities. Controlling for BMI showed that neonates of fastingmothers were 71 gram higher than those of non-fasting mothers, however theseresults were not significant. The study concluded no effect of Ramadan on childbirth weights Kavehmanesh and Abolghasmi, 2004.

Kraemer, 2000 found very surprisinglyfinding regarding fetal and neonatal mortality higher among girls inChinese-American also with poor health condition after birth. A Prospectivestudy was conducted in Yemen, Sana’s city on effect of Ramadan fasting onpregnant diabetic mothers. 90.3% pregnant diabetic women are likely to be fastmore than 20 days and there is no relationship in between Lower birth weight.Malhotra et al. (1989) studied the metabolic changesduring Ramadan for a sample of fasting eleven pregnant women of Asia. The samplewas compared with the control group of normal mothers observing fast. There wasa significant fall in the glucose, insulin, lactate and carnitine and a rise in, non-esterified fatty acid, triglycerideand 3-hydroxybutyrate none of the fasting mothers from control group had anormal biochemical reading at the end of fasting.

The pregnancy outcomes in thetwo groups were comparable.In a cohort study of 70 Jordanianstudents on different anthropometric parameters and they found Ramadan has asignificantly lower impact in comparison of pre-Ramadan, another importantresults is that after 2 weeks of Ramadan body weight and other parameter have atendency to retrieve pre-Ramadan status but still lower significant impactbefore pre-Ramadan. Ramadan fasting on serum lipid levels may be closelyrelated with nutritional diet and biochemical response to starvation Mansi, 2007.Sex ratio at birth and maternalnutritional status of 740 Britain females before conception, after 14 weekgestation length and 28 weeks gestation length they found no significant impactin case of male offspring with differences of nutritional intake but a profoundsignificant impact of male offspring if nutritional level is higher beforeconception. Dietary intake especially cereals played an important role oninfant sex Mathews et al, 2008.Restricted maternal nutrition isassociated with higher risk of neonatal admission in SCBU Mirghani and Hamud,2006. In a study conducted in UAE by Mirghani et. al.

(2004) of healthwomen observing Ramadan at a thirty weeks of gestation period with a controlgroup of non-fasting women to determine the fetal biophysical profile foundsignificant differences among the fetal bio profile of fasting and non-fastingmother. The study concluded that fetal breathing movement are reduced whenmother is fasting on the same day.During pregnancy period highly recommended by doctors”Eat small to moderate-sized meals at regular intervals, and eat nutritioussnacks”. This is the best way to get proper nutrition requirement for you andyour baby. Institute of medicine, 1992: 45. The health effects of fasting on pregnantwomen may further be gauged by a comparative study conducted by Metzger et al. 1982 documented a set of divergentmetabolic changes on conceived mother who skipped breakfast especially onsecond trimester. They studied the impact of Ramadan fasting among twenty-seven non pregnant and twenty-one pregnant womenwith the same characteristics, of “circulating fuels and glucoseregulatory hormones.

  The level changedrastically when overnight fasting was extended to the following afternoon inpregnant women”. Further the level of plasma glucose and alanine was loweramong pregnant women after twelve hours of fasting.These kinds of changes are termed as ‘accelerated starvation’ which are proneto impact the cognitive functions negatively Rizzo et al., 1991.

A study in Tehran was conducted for women facing oneof the trimester during Ramadan dividing into four groups, non-fasting, 1-10days fasting, 11-20 days, 21-30 days fasting. No significant differences wereobserved between BMI at thebeginning of pregnancy, mother’s age, number of pregnancies, and a history ofabortion in different groups. Also no significant differences between pregnancyoutcome parameters and fasting at different trimestersKiziltan et. Al (2005)analyzed the nutritional status of the pregnant fasting mothers during Ramadanand compared them with a control group of non-fasting mothers. The weight gainand energy intake was lower in the fasting pregnant mothers compared to thecontrol group during third trimester. The percentage of protein for first andsecond trimester and carbohydrates for all trimester was higher in fastingmothers. They observed a slight increasein the fasting blood glucose, serum total cholesterol high-densitylipoprotein-cholesterol and triglycerides. The study concluded that there wereno adverse nutritional effects of Ramadan on fasting mothers.

  Bilson et. al(2016) investigated the sample of 187 pregnant women in a n antenatalcare centre in jakarta. They found that the adherence to fasting was reduced by4% with every week increase in gestation period, and increased by 10% for everyone unit increase of women’s pre pregnancy body mass index (BMI). The regressionanalysis for fasting women was found to be negatively associated with women’sgestational age, fear of possible adverse effects of fasting on their own orthe fetal health, and with opposition from husbands. In conclusion, earliergestational age during Ramadan, husband’s opinion and possibly higher prepregnancy BMI, and influence women’s adherence to Ramadan fasting duringpregnancy.

In a natural experiment of Chinese famine 1959-1961byusing the 1% sample of census 2000 they found if the fetal exposure to acutemalnutrition had many demographic and exogenous demographic characteristics. Itis also reduces the birth of male offspring Almond et al, 2007.Asking et al, 1999 investigate the Swedishpopulation-based study to examine all women between 1987-95, who facedhyperemesis gravidarum during pregnancy and compared their sex ratio. Resultsshows that those women’s they faced hyperemesis gravidarum during earlypregnancy have a positive association of female offspring. No evidence wasfound during second and third trimester.

Shahgheibi at al. 2005 mainly focused on thirdtrimester of pregnancy with different anthropometric measurement of 179 newbornbabies. 33 grams low birth weight, 0.2-centimeter lower birth length was foundwith insignificant results.