Hematologic safety of Ramadan fasting during pregnancy: A prospective cohort study of haemoglobin and ferritin

Background: Some studies have linked fasting during pregnancy to negative results in specific individuals, especially those with low iron intake or preexisting anemia. Mothers' and infants' health impacts from Ramadan fasting are less understood. Aim of study: To study the iron level in fasting pregnant women compared to non-fasting pregnant women to address this conflict. Methods: A cohort study conducted at an Obstetrics and Gynecology private clinic, Kirkuk, Iraq during a period of two year from January 2022 to January 2025. It included 756 pregnant women who visited the private clinic for antenatal care and follow up of pregnancy and divided into two groups: Fasting group included 496 pregnant women who fasted during Ramadan during one of the pregnancy trimesters and non-fasting group included 260 pregnant women who didn’t fast during the pregnancy. Laboratory evaluation for a definitive diagnosis of iron deficiency and iron deficiency anemia was done for all participants before and after Ramadan. Results: Non-significant changes in hematological parameters seen within both fasting and non-fasting groups over the fasting period. Also, between-group comparisons did not demonstrate statistically significant differences for the primary endpoints after adjustment for multiple comparisons. The fasting duration stratified analysis revealed that these parameters changed across all duration periods in fasting women; and these changes were not statistically significant. They underscore the potential importance of nutritional support and surveillance rather than fasting per se as determinants of hematologic health in pregnancy Conclusion: Within a typical Ramadan fasting window and with standard prenatal care, hematologic parameters may remain stable. Muslim women underscore the potential importance of nutritional support and surveillance rather than fasting per se as determinants of hematologic health in pregnancy.