When the month of Ramadan happened to coincide with Piper Van Ness's first pregnancy, she made a decision: She'd attempt to fast daily from sunrise to sunset (which is customary for practicing Muslims during the holy month). If she felt well, she'd keep up the practice. If not, she'd simply excuse herself from fasting.
But things went well for Van Ness, who wound up fasting during Ramadan throughout all four of her pregnancies and while breastfeeding her children.
"For me it was pretty easy actually," the stay-at-home mom told Parents.com. "It's different for everybody—I know a lot of people don't fast while they're pregnant. I was kind of nervous at first but [my husband and I decided I would] try it and see how it goes. I just made sure to get enough nutrients and water when I broke my fast. To me, it wasn't a big deal."
But not every Muslim woman chooses to fast if Ramadan falls while she is pregnant—this is a pretty solid excuse, from both a religious perspective and a health point-of-view.
"The common [religious] advice is to have a medical excuse in order to be excused from it Islamically," Van Ness explained—but she simply didn't view pregnancy as a medical emergency. She was determined, but she was also lucky: She had four low-risk, complication-free pregnancies and was generally in good health. Her doctor was on board with her fasting through the month, provided she felt well enough. As a stay-at-home mom, Van Ness was able to take it easy through the days. And unlike many of her friends, she didn't feel any nasty side effects while fasting through her pregnancies.
"I have friends who said it was very clear it wouldn't work out for them," Van Ness shared. "They felt really sick or vomited or had blood pressure problems or growth problems with the fetus. You don't want to [take that risk]."
The safety of fasting during pregnancy is not a black-and-white issue. "Assuming it's an otherwise normal pregnancy with no other issues, the only thing [pregnant women should worry about is] maintaining adequate hydration. [The should] make sure [they're getting lots of fluids] before and after the fast–early in the morning if they're able to wake up [before sunrise] and in the evening when they're breaking the fast," OBGYN Scott Chudnoff, MD, told Parents.com.
According to Dr. Chudnoff, there haven't been many studies looking at the effects of fasting during pregnancy, but existing research shows no relationship to preterm delivery among women with normal, healthy pregnancies.
However, the risks may differ for women who have certain issues. "Diabetic patients may have more significant issues as it relates to controlling their diabetes, which could have an untoward effect on the pregnancy," said Dr. Chudnoff. "Other concerns would be patients who have hypertensive disorders and may be taking medications for that hypertension if they're at risk for preeclampsia or preterm delivery. In most cases, these concerns surround dehydration."
"The other patients who [need to be careful] are those who have placenta previa, where the placenta is growing across the opening of the uterus and cervix area," Dr. Chudnoff continued. "The biggest issue is that when women get dehydrated, the uterus can become irritable and start contracting. That doesn't necessarily mean the patient will go into preterm labor, but in patients who are at risk for placental problems, we try as much as possible to keep the uterus as calm as possible. Those are circumstances where more caution needs to be exerted."
Women carrying multiples—whose pregnancies are automatically classified as high-risk—are "absolutely" at increased risk of complications as well, according to Dr. Chudnoff.
As for caloric needs, Dr. Chudnoff is not concerned. According to him, pregnant patients should simply redistribute those calories to ensure they're taking in as many nutrients as they normally would before and after their fasts.
While Van Ness didn't find it tough to fast through pregnancy, the postpartum period may present some challenges for breastfeeding moms.
"I think [fasting while breastfeeding] is harder than fasting while pregnant," Van Ness admitted. Since breastfeeding can make a mother hungrier and thirstier than normal, going all day without food or drink (yes, even water) can certainly be more challenging and concerns about dwindling milk supply are valid.
According to Dr. Chudnoff, moms should speak to their children's pediatricians before choosing to fast while nursing, and they may also want to consider supplementing with formula while doing so. Again, dehydration is a possibility, and nursing moms should be very vigilant about taking in enough water before and after their fasts.
Ultimately, deciding whether or not to fast during Ramadan is a personal choice—the condition of your pregnancy, your symptoms, your doctor's opinions, and your own comfort are all worth considering. Provided your doctor is fine with it, you can do what Van Ness did: Attempt a day of fasting while giving yourself permission to break the fast and hold off for the rest of the month if you're simply not feeling up to it. Or, you can simply fast for a few days during Ramadan instead of throughout the month, which Dr. Chudnoff said may decrease your risks.
But when it comes right down to it, you have to understand the implications.
"You're going to very rarely find a doctor who is going to say it's OK to fast. There's always a big question mark. We don't know, there may be an underlying issue that's not diagnosed that may come to a head during the course of fasting," said Dr. Chudnoff. "At the same time, very few doctors can [give you] a specific reason why you can't fast. It's not [about whether you'll] get permission. People will do what they want to do. The most I can do is explain the risks. It's a free world. "