Maternal and Perinatal Effects of Ramadan Fasting during Pregnancy A Systematic Review and Meta-Analysis

Abstract

The current review is to clarify the evidence base available on maternal and perinatal effects of Muslim Ramadan fasting during pregnancy through systematic review of published literature in medical journals and databases and meta-analysis of the results of the studies to be included in the review. Searches were carried out in EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar,. Reference lists of eligible studies were checked by two reviewers for other potentially eligible studies for inclusion. The search was limited by dates from 1998 to 2018 and also was limited to English-only publications. Meta-analysis was performed using comprehensive metaanalysis version 3.0 software. In case of quantitative outcomes Mean±SD and total sample count were collected then the mean differences were pooled to calculate the weighted mean, while in case of qualitative outcomes events and total sample count were collected then the relative rates were pooled to calculate the weighted relative rate. Heterogenity (I2) index was calculated to test variation of pooled estimated for each outcome. Forest plot were used to present the individual and weighted estimates. The level of significance was taken at P value < 0.050 is significant, otherwise is non-significant. Primary outcome investigated was Fetal growth parameters and secondary outcomes investigated were Maternal weight gain, Mode of delivery, Average, minimum and maximum no. of fasting hours per day, Average, minimum and maximum no. of fasting days per month, Sense of unbearable weakness and fatigability, Ketonuria/ketonemia, Serum insulin level, Blood glucose level, Blood urea and creatinine levels, Umbilical and middle cerebral arteries Doppler indices, Amniotic fluid volume, Fetal heart rate tracing, Maternal perception of fetal movements, Gestational age at delivery, Anthropometric measurements, Need for NICU admission, Congenital malformations.