Breastfeeding in Ramadan

Breastfeeding in Ramadan

by Dr. Deena Kishawi

 

What is Ramadan?

Ramadan is the holiest month in Islam. Globally, there are 1.9 billion Muslims and one of the tenets of Islam is to fast during the holy month of Ramadan. Because the Islamic calendar is lunar-based, the dates of this month change from year to year. In 2024, Ramadan will most likely start around March 10th and end April 9th. During Ramadan, observant Muslims abstain from food, drink (including water and coffee), and sexual acts from dawn to sunset.

Who should fast in Ramadan?

Muslims who are healthy and physically able should fast in Ramadan. There are exceptions – including but not limited to women on their menses, those who are ill (either with chronic or acute illnesses), those who are traveling, the elderly, and prepubertal children.

Why do breastfeeding women want to fast?

Pregnant women and women who are breastfeeding are not exempt from fasting, however, if it becomes harmful to the mother and child, then maternal and fetal health should be prioritized and she should not continue fasting. They may also continue fasting because of the communal and spiritual connection they feel while fasting in Ramadan.

Is it safe to fast while breastfeeding? Will there be harm to my baby?

Although there is limited data about breastfeeding and the effects of fasting, research shows that fasting is not harmful to the baby or the mother. Macronutrients and the volume of breastmilk are not affected by fasting during Ramadan, however, there can be some variation in the level of micronutrients present in the milk. Research has also shown that the baby’s weight is not affected by fasting while breastfeeding.

Are there any specific recommendations in regards to diet?

Breastfeeding requires at least another 400 calories plus an additional 500-1,000 mL of fluids. It’s incredibly quick to become dehydrated when you are breastfeeding because your fluids are going into the breastmilk and you’re not retaining as much as necessary for regular cell function. That’s why both hydration and nutrition needs are much greater when you are breastfeeding. It is imperative to drink enough fluids and maintain adequate hydration as not doing so can potentially pose harm to you, your baby, and your milk supply. If you are chronically dehydrated, it is prudent to consider abstaining from fasting until adequate hydration is met.

What about if I am exclusively breastfeeding?

Special considerations should be taken when fasting while exclusively breastfeeding. Because your baby will not receive any other nutrition than your breastmilk, it is imperative to make conscious decisions about nutritionally dense foods and maintain adequate hydration. This will ensure that your milk supply remains steady during Ramadan. Take a prenatal vitamin daily to ensure you are receiving the appropriate amount of macronutrients and micronutrients necessary for healthy breast milk. Continue providing Vitamin D supplementation for your baby while exclusively breastfeeding.

What if my milk supply starts decreasing?

Pay close attention to the number of feeds and the duration of each feed. This can give you a general idea of your milk supply. If you notice the duration of feeds or the number of feeds is decreasing, this may be a sign your milk supply is decreasing. While both you and your baby are getting adjusted to Ramadan, you may notice that your baby is more likely to feed during the night. If they are latching less often or not feeding for as long as usual, this might be because your milk supply is lessening. If you are not exclusively breastfeeding and your baby is older than 6 months, consider supplementing with formula or solid foods. If you are exclusively breastfeeding, consider fasting every other day or every third day to ensure you are receiving adequate hydration and nutrition.

Tips for breastfeeding while fasting:

  1. It is recommended to drink at least two liters of water daily. This will be hard if you don’t space out your water intake. Break your fast with a cup of water, drink a cup before and after praying (maghrib, isha, taraweeh, qiyam), and drink water during suhoor/sehri.
  2. If you do not drink enough fluids, you are at risk for dehydration. This can pose a harm to you and your milk supply.
  3. You must be eating calorie-dense and nutrient-dense foods, as well as an adequate amount of calories. Consider foods such as fish, lean protein, whole-fat dairy, whole grains, and nuts. Consider fruits and vegetables with high water content to help with hydration, such as cucumbers or watermelon.
  4. Consider supplementing your diet with a multivitamin to ensure that all the necessary nutrients are available to your baby through your breast milk. A prenatal vitamin is a great option.
  5. Wake up for suhoor/sehri to ensure that you are getting enough hydration and nutrition for yourself and baby. Consider eating a full meal alongside a nutrient-dense smoothie with fruits, vegetables, nut butter, dates, and milk/yogurt.
  6. Monitor the weight of your baby. If they are losing weight or maintaining the same weight, consider supplementing with formula or solid foods (if they are of the appropriate age). Otherwise, consider fasting every other day or every third day to meet adequate nutrition for you and your baby.
  7. Consider pumping or breastfeeding more often at night, when you can maintain adequate hydration.
  8. Monitor the baby’s mood. If they are fussy, continue crying after feeds, seem unwell, or have less wet diapers than usual, this could indicate that they are not receiving adequate nutrition. Consider supplementing with formula or solid foods (depending on the baby’s age) or fasting every other day.
  9. If you feel lightheaded, dizzy, or faint for longer than 30 seconds, break your fast. This is a sign that your blood sugar is too low or you are severely dehydrated.
  10. Take it easy. While fasting, do not participate in rigorous physical activity.
  11. Ultimately, the health of you and your baby is a priority. Do not continue fasting if you feel unwell or fatigued or if you notice that your baby is dehydrated or feeling unwell.

 

This is not personalized medical advice. Please speak with a practicing Muslim physician in conjunction with an Islamic scholar, and have a conversation about whether breastfeeding while fasting is safe for you. That way, you can make an informed decision about fasting while breastfeeding.

*Written by Deena Kishawi, MD. She is an obstetrician and gynecologist practicing in Chicago. She provides evidence-based management and guidelines for her patients, while also ensuring it is in concordance with Islamic values. She is an active member of the Darul Qasim Bioethics Cohort. Of note, the author is from the Shafi’ee Madhab which has this provision.

 

 

References (APA)

  1. Başıbüyük, M., Aktaç, Ş., Kundakçı, S., Büke, Ö., & Karabayır, N. (2023). Effect of Ramadan Fasting on Breast Milk. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, 18(8), 596–601. https://pubmed.ncbi.nlm.nih.gov/37615571/
  2. Rakicioğlu, N., Samur, G., Topçu, A., & Topçu, A. A. (2006). The effect of Ramadan on maternal nutrition and composition of breast milk. Pediatrics international : official journal of the Japan Pediatric Society, 48(3), 278–283. https://pubmed.ncbi.nlm.nih.gov/16732795/
  3. Al-Qahtani, A. M., Mohamed, H., & Ahmed, A. M. (2020). Knowledge, attitude and practice of Saudi women in Najran area towards breastfeeding during Ramadan. Sudanese journal of paediatrics, 20(1), 42–48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282434/
  4. AlZunaidy, N. A., Al-Khalifa, A. S., Alhussain, M. H., Mohammed, M. A., Alfheeaid, H. A., Althwab, S. A., & Faris, M. E. (2023). The Effect of Ramadan Intermittent Fasting on Food Intake, Anthropometric Indices, and Metabolic Markers among Premenopausal and Postmenopausal Women: A Cross-Sectional Study. Medicina (Kaunas, Lithuania), 59(7), 1191. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385901/

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