الفهرس 
Maternal metabolism in pregnancyOnly 14 pages are availabe for public view
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Abstract
Ramadan is the holy month for Islamic world. In Ramadan food and fluid ingestion is restricted to the Pre – Sunrise and Post – Sunset hours for 1 month every year (Reilly and Waterhouse, 2007). There are certain conditions that Muslims are allowed not to fast including pregnancy. However, fasting during pregnancy is a very common practice among Muslim women (Joosoph et al., 2004). Endocrine consequence of fasting Ramadan during pregnancy revealed significant fall in the concentration of both blood glucose and insulin with a concomitant rise of human placental lactogen throughout the first trimester, without any significant changes of other hormones and all parameters in the second and third trimesters (Malhotra et al., 1990). Pregnant women observing Ramadan provide a unique opportunity to study the effect of diet pattern on the uterine artery flow. Abnormal uterine artery doppler velocimetry (UADV) is associated with adverse pregnancy outcome (Mirghani et al., 2007). The most earlier reports suggested that fasting during Ramadan has no effects on Apgar scores, birth weight and gestational age at delivery or infants health .These data are insufficient to assure that fasting is completely safe during Ramadan. For instance, little is known about the effects of fasting on the amniotic fluid index in addition to some other parameters of fetal health (Naderi and Kamyabi, 2004).
The aim of this study is to evaluate whether metabolic changes due to fasting during Ramadan have any significant effects on maternal health and fetal development and wellbeing in healthy pregnant women.
Accordingly, the current study comprise 60 consecutive healthy pregnant women among these attending the ANC clinic of Benha University Hospital and divided into 2 groups:
Group I: Thirty pregnant healthy women with singleton uncomplicated pregnancies at 30 weeks or more of gestation who fast during month of Ramadan.
Group II: Thirty pregnant healthy women with singleton uncomplicated pregnancies at 30 weeks or more of gestation who didn’t fast during month of Ramadan.
Maternal blood samples were obtained one week prior to Ramadan and on 28th days of fasting for measurement of followings: Serum cortisol, Triglyceride, total cholesterol (TC), low – density lipoprotein (LDL), high – density lipoprotein (HDL), very low density lipoprotein (VLDL), glucose, serum insulin and urinary ketones.
Ultrasonography was performed on all subjects before and at the end of Ramadan, For the following measurements: increase of fetal biparietal diameter (BPD), increase of fetal femur length (FL), increase of estimated fetal body weight (EFBW), fetal biophysical profile (BPP), amniotic fluid index (AFI), umbilical artery and uterine artery systole /diastole (S/D) ratio.
The current study revealed the following:
• There is no statistically significant difference between the two groups regarding maternal age, parity, primary weight gain and mothers weight gain during one month. But there was a significant difference regarding the mean time since the last oral intake at the end of Ramadan fasting.
• In the present study, no significant difference was found between the two groups in terms of increase in EFBW and fetal biometry, also showed no significant difference in AFI, before and after Ramadan fasting.
• Statistically there is no difference in BPP of both groups at the end of Ramadan, both groups showed 13.3 % abnormal BPP (6/8).Breathing movement was the affected component
• Doppler indices of uterine and umbilical arteries showed there is no significant difference between both groups in the beginning and at the end of Ramadan.
• In our current study, the maternal serum cortisol was significantly higher at the end of Ramadan in the fasting group (P<0.05) . No significant increase was observed in total cholesterol and triglyceride levels. However, the increases in both parameters were significantly higher compared to those in control group.
• LDL and VLDL levels showed a non-significant decrease at the end of the Ramadan in both groups. HDL levels showed a significant increase in fasting group at the end of Ramadan (P<0.05).
• There is a statistically significant decrease in the serum glucose and serum insulin in the fasting group compared to control group•Also, Urinary ketones showed a significant increase at the end of Ramadan in the fasting group compared to control group (P=0.04).