Pregnancy and fasting in women with diabetes mellitus

Fasting during the Holy month of Ramadan is one of the obligatory prayer for all normal healthy Muslims. There are a few special situations as pregnant and breastfeeding women, who are exempted from fasting. Different surveys observed that 70-90% pregnant women prefer not to accept this fiqh. A complex series of metabolic and hormonal changes occur in pregnancy and this is augmented from fed to starvation stage during fasting from dawn to sunset. Adaptive metabolism is established by balance of insulin and other counter- regulatory hormones. This adaptive metabolism is decompensated by relative or absolute lack of insulin and exaggerated insulin resistance (IR) on preexisting defect altered by foeto-placental hormones. Thus in both fasting and fed states high blood glucose, triglycerides, free fatty acids and ketones are encountered. Unregulated fat catabolism with increased FFA and ketones can alter embryonic and foetal development. There is no definite consensus guideline on how to manage blood glucose during fasting in pregnant women with diabetes. Most authors advocate insulin therapy to manage diabetes. Pregnant women with diabetes who wish to fast during Ramadan must be aware of symptoms and signs of foetal and maternal distress, and must terminate the fast if these occur. More practical approach, with empathy, might be helpful instead of imposing absolute ban on fasting in women with pregnancy and diabetes.