Prenatal Exposure to Ramadan and Small Stature in Adulthood
Prenatal Exposure to Ramadan and Small Stature in Adulthood
A growing body of evidence suggests that maternal diet during pregnancy can lead to permanent alterations to the physiology of the fetus. It is unknown whether intermittent maternal fasting during Ramadan has long-term associations with the offspring's body composition. By using data from the third wave of the Indonesian Family Life Survey (2000), we compared the body mass indices (weight (kg)/height (m)) of Muslims who had been in utero during Ramadan with those of Muslims who had not been in utero during Ramadan. Adult Muslims who had been in utero during Ramadan were slightly thinner than Muslims who had not been in utero during Ramadan (adjusted adult body mass index: −0.32, 95% confidence interval: −0.57, −0.06). Those who were conceived during Ramadan also had smaller stature, being on average 0.80 cm shorter than those who were not exposed to Ramadan prenatally. Among non-Muslims, no such associations were found. This study suggests that exposure to Ramadan during pregnancy may have lasting consequences for adult body size of the offspring.
A growing body of evidence suggests that maternal diet during pregnancy can permanently program the fetus and thereby affect its later health. Previous studies of drastically reduced nutritional intake during pregnancy have reported both increases (mainly among women) and decreases in adult offspring's body mass index (BMI, measured as weight (kg)/height (m)). It is unknown whether intermittent maternal fasting during Ramadan has long-term effects on the offspring's body composition. Ramadan is the ninth month of the Islamic lunar calendar, and fasting during Ramadan is a religious obligation for healthy Muslim adults. When observing Ramadan, people consume no food or drink (including water) from dawn to sunset. They often reduce their levels of activity during the day and are more active at night. Studies have shown that body weight tends to decrease during Ramadan in both men and women. It has been suggested that this is mainly an effect of decreased fluid intake, although reduced caloric intake has also been reported, particularly among pregnant women. Although pregnant women are allowed to defer fasting until after pregnancy, many pregnant women prefer to share the spiritual and social experiences of Ramadan with their families, or they want to avoid having to make up for the fast after pregnancy, as religious rules prescribe. Around 70%–90% of Muslim women around the world, including those in Singapore, Iran, the United Kingdom, and West Africa, report fasting during pregnancy.
Pregnant women who fast during Ramadan have been shown to have symptoms of accelerated starvation, which is characterized by low serum levels of glucose and alanine and especially high levels of free fatty acids. Depending on its timing during gestation, Ramadan fasting has been shown to be associated with the size of the baby and the placenta at birth. Almond and Mazumder and Van Ewijk showed that prenatal exposure to Ramadan is associated with health problems later in life.
This study investigates the association of Ramadan exposure during pregnancy with adult offspring anthropometry. We used data from Indonesia, a country with 2 important advantages to those studying this topic. First, it is the country with the largest Muslim population in the world: 86% of its 246 million citizens are Muslims. Second, Indonesia's location on the equator means that daylight times, and thus fasting times during Ramadan, are about the same each year (about 13.5 hours), irrespective of the Gregorian month in which Ramadan falls.
Abstract and Introduction
Abstract
A growing body of evidence suggests that maternal diet during pregnancy can lead to permanent alterations to the physiology of the fetus. It is unknown whether intermittent maternal fasting during Ramadan has long-term associations with the offspring's body composition. By using data from the third wave of the Indonesian Family Life Survey (2000), we compared the body mass indices (weight (kg)/height (m)) of Muslims who had been in utero during Ramadan with those of Muslims who had not been in utero during Ramadan. Adult Muslims who had been in utero during Ramadan were slightly thinner than Muslims who had not been in utero during Ramadan (adjusted adult body mass index: −0.32, 95% confidence interval: −0.57, −0.06). Those who were conceived during Ramadan also had smaller stature, being on average 0.80 cm shorter than those who were not exposed to Ramadan prenatally. Among non-Muslims, no such associations were found. This study suggests that exposure to Ramadan during pregnancy may have lasting consequences for adult body size of the offspring.
Introduction
A growing body of evidence suggests that maternal diet during pregnancy can permanently program the fetus and thereby affect its later health. Previous studies of drastically reduced nutritional intake during pregnancy have reported both increases (mainly among women) and decreases in adult offspring's body mass index (BMI, measured as weight (kg)/height (m)). It is unknown whether intermittent maternal fasting during Ramadan has long-term effects on the offspring's body composition. Ramadan is the ninth month of the Islamic lunar calendar, and fasting during Ramadan is a religious obligation for healthy Muslim adults. When observing Ramadan, people consume no food or drink (including water) from dawn to sunset. They often reduce their levels of activity during the day and are more active at night. Studies have shown that body weight tends to decrease during Ramadan in both men and women. It has been suggested that this is mainly an effect of decreased fluid intake, although reduced caloric intake has also been reported, particularly among pregnant women. Although pregnant women are allowed to defer fasting until after pregnancy, many pregnant women prefer to share the spiritual and social experiences of Ramadan with their families, or they want to avoid having to make up for the fast after pregnancy, as religious rules prescribe. Around 70%–90% of Muslim women around the world, including those in Singapore, Iran, the United Kingdom, and West Africa, report fasting during pregnancy.
Pregnant women who fast during Ramadan have been shown to have symptoms of accelerated starvation, which is characterized by low serum levels of glucose and alanine and especially high levels of free fatty acids. Depending on its timing during gestation, Ramadan fasting has been shown to be associated with the size of the baby and the placenta at birth. Almond and Mazumder and Van Ewijk showed that prenatal exposure to Ramadan is associated with health problems later in life.
This study investigates the association of Ramadan exposure during pregnancy with adult offspring anthropometry. We used data from Indonesia, a country with 2 important advantages to those studying this topic. First, it is the country with the largest Muslim population in the world: 86% of its 246 million citizens are Muslims. Second, Indonesia's location on the equator means that daylight times, and thus fasting times during Ramadan, are about the same each year (about 13.5 hours), irrespective of the Gregorian month in which Ramadan falls.