Last update May 4, 2021

Religious fasting in Ramadan

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Many Muslim breastfeeding mothers fast (from sunrise to sunset) during the month of Ramadan (Khalife 2015, Kridli 2011), regardless of the country they live in or their level of education (Jessri 2013, Mubeen 2012, Rashid 2007, Agnew 1997, Prentice 1983).

From a religious point of view, pregnant and lactating mothers are exempted from the obligation to fast if, due to various circumstances, they fear for the health of themselves or their baby.
Several circumstances may affect a mother’s decision including: the baby's age, prematurity, the baby’s health, exclusivity of breastfeeding, maternal health and nutritional status, maternal employment, other young siblings to attend to, and whether the month of Ramadan occurs in winter or summer.

For some authors they should be exempt in any situation (Khalife 2015, Mubeen 2012, Shaikh 2006, Agnew 1997), according to others, they are excused if there is reason to believe that fasting can cause them or their babies harm (Rashid 2007, Shaikh 2006).
In any case, fasting is postponed to a later date (Shaikh 2006, Agnew 1997).

There are few studies that have researched possible changes in breast milk and the safety and impact of breastfeeding due to Ramadan fasting (Bajaj 2012, Kridli 2011).

In extreme heat conditions (Gambia) significant changes in milk composition (increase of sodium and osmolarity and decrease of lactose) have been found during fasting hours (Prentice 1984). A decrease in micronutrients such as zinc and magnesium has been found (Rakicioğlu 2006).

During fasting hours, breastfeeding mothers compared to non-breastfeeding women have a slightly higher degree of dehydration (4.9% vs 3.8%) but in any case it is mild (Prentice 1984) and they do not undergo clinically significant metabolic alterations (Rakicioğlu 2006, Agnew 1997, Prentice 1984). One in five women noted decreased milk production during Ramadan fasting and an increase in milk supplements was observed in infants less than six months old (Bajaj 2012, Ertem 2001).

Changes in the macronutrient composition of breast milk are not of major clinical significance and the growth of infants is not affected (Allegaert 2020, ABA 2018, Rakicioğlu 2006, Agnew 1997).
Nor do the levels of prolactin change in the mother or other hormones involved or not in the reproduction process (Cağlayan 2014, Prentice 1984, Prentice 1983). Breastfeeding mothers gain on average 1 kg following Ramadan without significant changes in body mass index (Rakicioğlu 2006).

It is prudent for breastfeeding mothers who choose to fast to drink plenty of fluids, and eat nutritious food between dinner and dawn to compensate for daytime losses, avoid excessive daytime activity, and know the signs of risk that would justify - on religious grounds - breaking the fast, such as extreme fatigue, dizziness, nausea or vomiting (Khalife 2015), whilst monitoring their milk production (Bajaj 2012).
Some authors, doctors and pediatricians, advise breastfeeding mothers against fasting (Rakicioğlu 2006) especially in the case of exclusively breastfeeding infants under 6 months (Bajaj 2012).
(For more information see ABA 2018 and Paricio, APILAM Blog 2017).

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

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Religious fasting in Ramadan belongs to this group or family:

References

  1. Allegaert K, Smits A. Acute Maternal Fasting or Fluid Abstention Does Not Significantly Affect the Macronutrient Composition of Human Milk: Clinical and Clinical Research Relevance. Children (Basel). 2020 Jun 10;7(6). pii: E60. Abstract
  2. ABA. (الجمعية الاسترالية للرضاعة الطبيعية) الرضاعة الطبيعية: وشهر رمضان 2018 Abstract Full text (link to original source) Full text (in our servers)
  3. ABA. Australian Breastfeeding Association. Breastfeeding: and Ramadan. 2018 Abstract Full text (link to original source) Full text (in our servers)
  4. Paricio Y, Paricio JM. Breastfeeding and fasting during Ramadan. APILAM Blog. 2017 Full text (link to original source)
  5. Paricio Y, Paricio JM. Lactancia materna y ayuno durante el Ramadán. Blog de APILAM. 2017 Full text (link to original source)
  6. Khalife T, Pettit JM, Weiss BD. Caring for Muslim patients who fast during Ramadan. Am Fam Physician. 2015 Abstract
  7. Cağlayan EK, Göçmen AY, Delibas N. Effects of long-term fasting on female hormone levels: Ramadan model. Clin Exp Obstet Gynecol. 2014 Abstract
  8. Jessri M, Farmer AP, Olson K. Exploring Middle-Eastern mothers' perceptions and experiences of breastfeeding in Canada: an ethnographic study. Matern Child Nutr. 2013 Abstract
  9. Mubeen SM, Mansoor S, Hussain A, Qadir S. Perceptions and practices of fasting in Ramadan during pregnancy in Pakistan. Iran J Nurs Midwifery Res. 2012 Abstract
  10. Bajaj S, Khan A, Fathima FN, Jaleel MA, Sheikh A, Azad K, Fatima J, Mohsin F. South Asian consensus statement on women's health and Ramadan. Indian J Endocrinol Metab. 2012 Abstract Full text (link to original source)
  11. Kridli SA. Health beliefs and practices of Muslim women during Ramadan. MCN Am J Matern Child Nurs. 2011 Abstract
  12. Rashid H. Ramadan fasting and breast milk. Breastfeed Med. 2007 Abstract
  13. Rakicioğlu N, Samur G, Topçu A, Topçu AA. The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatr Int. 2006 Abstract
  14. Shaikh U, Ahmed O. Islam and infant feeding. Breastfeed Med. 2006 Abstract
  15. Ertem IO, Kaynak G, Kaynak C, Ulukol B, Gulnar SB. Attitudes and practices of breastfeeding mothers regarding fasting in Ramadan. Child Care Health Dev. 2001 Abstract
  16. Agnew T, Gilmore J, Sullivan P. A Multicultural Perspective of Breastfeeding in Canada. Minister of Public Works and Governement Services Canada. 1997 Full text (link to original source) Full text (in our servers)
  17. Agnew T, Gilmore J, Sullivan P. Perspective multiculturelle de l’allaitement maternel au Canada. Santé Canada. Ministère de Travaux publics et Services gouvernementaux. 1997 Full text (link to original source) Full text (in our servers)
  18. Prentice AM, Lamb WH, Prentice A, Coward WA. The effect of water abstention on milk synthesis in lactating women. Clin Sci (Lond). 1984 Abstract
  19. Prentice AM, Prentice A, Lamb WH, Lunn PG, Austin S. Metabolic consequences of fasting during Ramadan in pregnant and lactating women. Hum Nutr Clin Nutr. 1983 Abstract

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