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. 2021 Nov;35(6):689-693.
doi: 10.1111/ppe.12761. Epub 2021 May 26.

Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada

Julie Bernier  1   2 , Marianne Bilodeau-Bertrand  2 , Améyo Djeha  2 , Nathalie Auger  2   3   4   5
Affiliations

Ramadan exposure during early pregnancy and risk of stillbirth in Arab women living in Canada

Julie Bernier et al. Paediatr Perinat Epidemiol. 2021 Nov.

Abstract

Background: Data on fasting during Ramadan and the risk of preterm birth and child mortality are conflicting, but the association with stillbirth is unknown.

Objective: We studied the relationship between Ramadan and the risk of stillbirth for Arab women in Quebec, Canada.

Methods: We conducted a retrospective cohort study using birth certificates for Arab women in Quebec, Canada, between 1981 and 2017. The exposure was Ramadan in the first and second trimester (1-27 weeks of gestation), and the outcome was early (<28 weeks) or late (≥28 weeks) stillbirth. We used log-binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) for the association between Ramadan and risk of stillbirth. We adjusted models for maternal characteristics and assessed associations by cause of death.

Results: The study included 78,349 live births and 274 stillbirths. There were 3.5 stillbirths per 1,000 pregnancies for women exposed to Ramadan between weeks 1-27 of gestation (95% CI 3.0, 4.0), and 3.4 per 1,000 for unexposed women (95% CI 2.8, 4.1). Compared with no exposure, Ramadan between weeks 1-27 was not associated with the risk of early (RR 1.32, 95% CI 0.76, 2.28) or late stillbirth (RR 0.93, 95% CI 0.70, 1.23) in adjusted models. RRs for early stillbirth were 1.40 for Ramadan between weeks 15-21 (95% CI 0.70, 2.80) and 1.38 for Ramadan between weeks 22-27 (95% CI 0.67, 2.84). Relative to no exposure, Ramadan between weeks 15-21 was associated with early stillbirth due to congenital anomaly (RR 3.96; 95% CI 1.35, 11.57) in unadjusted models. There was no association with other causes of stillbirth.

Conclusions: There is no evidence that Ramadan is associated with the risk of early or late stillbirth overall. Further research is needed to confirm an association with stillbirth due to congenital anomalies.

Keywords: Arabs; fasting; pregnancy outcome; stillbirth.

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References

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