All pregnant women should be counselled pre-Ramadan and during fasting-Shabeen Naz Masood


Diabetes and Ramadan Conference by BIDE-BMU
All pregnant women should be counselled
pre-Ramadan and during fasting-
Shabeen Naz Masood
CKD-4&5 patients must not fast & CKD-3
should not fast-Rayaz Malik

KARACHI: Prof. Najmul Islam alongwith Prof. Saeed Mahar chaired the first session on Day-2 of the Diabetes and Ramadan Conference organized by Baqai Institute of Diabetology & Endocrinology (BIDE) in collaboration with Baqai Medical University on March 24th 2019. Prof. Shabeen Naz Masood consultant obstetrician & gynecologist was the first speaker who talked on Pre-Ramadan Health seeking behaviour, fasting trends, eating patterns and sleep cycles in pregnant women.

Prof. Shabeen Naz Masood

She pointed out that there are 1.4 Billion Muslim in the world which forms almost 24% of the world population. Healthcare professionals should reduce the possibility of negative impact of Ramadan fasting in pregnancy. She then gave highlights from her study showing fasting trends and said that it included 279 women between the age of 16-35 years. Almost 98% were housewives, 63% were primary gravida and 85% has one to ten days fasting during Ramadan, 4-8% reported fasting for 11-20 days while 72% had no pre Ramadan counselling and 91% were not aware of its importance.

Prof. Saeed Mahar alongwith Prof. Najmul Islam and Prof. Asher  Fawwad chairing
one of the scientific sessions during the Diabetes & Ramada conference
organized by BIDE-BMU at Karachi recently.

In this study 21% of these patients were counselled by doctors and nurses but 29.8% asked and sought advice from Muslim scholars. Fasting is not allowed during Menstruation and post-partum bleeding, frequent breast feeding and not good health are expected from fasting. Almost 64% of the pregnant women do not feel any fetal movements. Fasting had no effect on birth weight and height. Usual sleep hours during Ramadan was three to four hours. The patients can also expect prolonged labour and more pain. They should be prepared to break fast if hypoglycemic symptoms appear. The healthcare professionals should discuss with the patient the warning signs and provide them information how to fast safely. These patients also need increased prenatal supervision. She also talked about the medical reasons for not fasting. She suggested that the husband of pregnant women should also be involved in counselling if she wish to fast. Assess the risk factors. Fasting becomes difficult during the first trimester due to vomiting. These patients can experience premature labour after thirty weeks and because of less water, they can also experience early uterine contractions and all these things should be told to the patients. All pregnant women should be counselled by physician’s pre Ramadan and during Fasting as it poses major risk to mother and fetus.

Renal disease and Fasting

Dr. Rayaz A. Malik was the next speaker who discussed Can patients with renal disease fast? He shared in detail different opinions, cautions, reviews and statements and pointed out that there are very few good studies on the topic. IDF-DAR practical guidelines based on recommendations lack evidence. He suggested that patients with CKD-4&5 must not fast, CKD-3 should not fast. CKD 1 & 2 has moderate low risk and it depends on the ability of the individual to fast. Referring to a Review published in 2014 he said that fasting during CKD had no serious side effects. There was no organ rejection in 463 renal transplant patients. Renal changes are reversible ten days at the end of fasting. Fasting is not associated with deterioration of chronic kidney disease showed a study conducted in 2017. However, repeated Ramadan fasting adversely affect kidney function in renal transplant patients. The patients must stop fasting if creatinine increases by 30%. Some of these patients may have increase in weight by two KG. They may suffer from dizziness, anorexia, fatigue, weakness, lethargy. Their blood pressure, body weight, electrolytes should be checked weekly. They should be advised to avoid use of high potassium diet at Iftar, he added.

Dr. Rayaz A. Malik

Dr. Asma Deep discussed fasting among adolescents with diabetes and the need for consensus management. She opined that more studies are needed in Paediatric population. Almost 80% of adolescents will be able to fast. One of the surveys showed that children aged fourteen years were able to fast. There is variability in the opinion of experts. We do not see hypoglycemia mostly in children. With right dose of basal insulin these patients will not go into hypoglycemia. She further stated that reduction in the dose of basal insulin does not reduce the risk of hypoglycemia. Her conclusions were that there is a variety in practice in Ramadan and we lack consensus on management. There is a need for guidelines, more RCTs are needed and it was high time that we start some multicenter studies. ISPAD guidelines are now almost ready on which we have been working for quite some time, she added.

Dr. Asma Deep

During the discussion it was pointed out that diabetics with creatinine level of 20-25 can fast and they say they had no problems. Fasting itself has no deterrent effect. The physicians must give good advice and let the patient decide to fast or not to fast. Dr. Rayaz Malik said that he tells his patients that he will see them every week if they fast. Prof. Najmul Islam said that he will not advice his patients with CKD-4&5 to fast. Give them advice to take plenty of water, see these patients frequently to keep them safe. Prof. Saeed Maher said that if patients wish to fast, see these patients every week as weather is different in different regions, countries.

Benefits of Fasting
in patients with CVD

Dr. Kalimullah Shaikh discussed the benefits of fasting in patients suffering from cardiovascular diseases. He pointed out that we have more young patients in Pakistan. Cardiovascular diseases should be prevented at primary level. Fasting leads to decrease in cholesterol and TGs, blood pressure also reduces and HDL goes up. It promotes detoxification, reduces inflammatory response, and leads to weight loss, boosts immunity and increase fat breakdown. Reduction in blood pressure leads to decrease in myocardial infarction. Studies have shown that there is 25% reduction in lipid levels by fasting. Patients with severe epilepsy, migraine should not fast. Control of diabetes will lead to better control of hypertension and weight loss.

Dr. Kalimullah Shaikh

Prof. Najmul Islam commenting on the presentation remarked that there are no adverse effects of fasting on cardiovascular disease but it has lot of benefits. Dr. Uzma visiting Diabetologist from United States remarked that in the West, people go for intermittent fasting to enjoy its benefits. She further stated that we will not get benefits if we do not work, enjoy good quality of healthy food and share it with others, she added.

Group photograph of BIDE team which organized the Diabetes & Ramadan Conference
held at Karachi during April 2019.

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