{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:51:20Z","timestamp":1784307080365,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001655","name":"German Academic Exchange Service","doi-asserted-by":"publisher","award":["57440921"],"award-info":[{"award-number":["57440921"]}],"id":[{"id":"10.13039\/501100001655","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Health outcomes of in utero Ramadan exposure have been reported in a systematic literature review; however, the available literature on long-term effects were not fully covered. Our study aims to specifically review the long-term outcomes of in utero Ramadan exposure. We searched for original research articles analyzing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes. Sixteen studies from 8304 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health, as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months, and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower mathematics, writing and reading scores, as well as a lower probability to own a home were associated with Ramadan exposure during conception or the first trimester of pregnancy. Furthermore, age and sex seem to play a pivotal role on the association. Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.<\/jats:p>","DOI":"10.3390\/nu13124511","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T02:50:18Z","timestamp":1639968618000},"page":"4511","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Long-Term Outcomes of in Utero Ramadan Exposure: A Systematic Literature Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3391-934X","authenticated-orcid":false,"given":"Melani R.","family":"Mahanani","sequence":"first","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-0078","authenticated-orcid":false,"given":"Eman","family":"Abderbwih","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-1900","authenticated-orcid":false,"given":"Amanda S.","family":"Wendt","sequence":"additional","affiliation":[{"name":"Potsdam Institute for Climate Impact Research, Member of the Leibniz Association, P.O. Box 601203, 14412 Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0526-6249","authenticated-orcid":false,"given":"Andreas","family":"Deckert","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5524-2099","authenticated-orcid":false,"given":"Khatia","family":"Antia","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9873-5686","authenticated-orcid":false,"given":"Olaf","family":"Horstick","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1086-6866","authenticated-orcid":false,"given":"Peter","family":"Dambach","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-7506","authenticated-orcid":false,"given":"Stefan","family":"Kohler","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9974-1145","authenticated-orcid":false,"given":"Volker","family":"Winkler","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1038\/sj.ejcn.1601899","article-title":"Effects on health of fluid restriction during fasting in Ramadan","volume":"57","author":"Leiper","year":"2003","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13135","DOI":"10.1111\/mcn.13135","article-title":"Women\u2019s fasting habits and dietary diversity during Ramadan in rural Bangladesh","volume":"17","author":"Seiermann","year":"2021","journal-title":"Matern. Child Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.12669\/pjms.315.7649","article-title":"The effect of Ramadan fasting on cardiometabolic risk factors and anthropometrics parameters: A systematic review","volume":"31","author":"Mazidi","year":"2015","journal-title":"Pak. J. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1007\/s10943-013-9687-0","article-title":"Does Ramadan Fasting Alter Body Weight and Blood Lipids and Fasting Blood Glucose in a Healthy Population? A Meta-analysis","volume":"53","author":"Kul","year":"2014","journal-title":"J. Relig. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/00006842-200003000-00021","article-title":"Irritability during the month of Ramadan","volume":"62","author":"Kadri","year":"2000","journal-title":"Psychosom. Med."},{"key":"ref_6","first-page":"987","article-title":"Is Ramadan fasting related to health outcomes? A review on the related evidence","volume":"19","author":"Rouhani","year":"2014","journal-title":"J. Res. Med. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3936","DOI":"10.18203\/2320-1770.ijrcog20204275","article-title":"Ramadan fasting during pregnancy: Characteristics and outcomes","volume":"9","author":"Ghazal","year":"2020","journal-title":"Int. J. Reprod. Contracept. Obstet. Gynecol."},{"key":"ref_8","first-page":"583","article-title":"A survey of fasting during pregnancy","volume":"45","author":"Joosoph","year":"2004","journal-title":"Singap. Med. J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Baynouna Al Ketbi, L.M., Niglekerke, N.J., Zein Al Deen, S.M., and Mirghani, H. (2014). Diet restriction in Ramadan and the effect of fasting on glucose levels in pregnancy. BMC Res. Notes, 7.","DOI":"10.1186\/1756-0500-7-392"},{"key":"ref_10","first-page":"289","article-title":"The human fetus and newborn: Development of the immune response","volume":"19","author":"Hayward","year":"1983","journal-title":"Birth Defects Orig. Artic. Ser."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"377","DOI":"10.3945\/an.111.000570","article-title":"Nutritionally mediated programming of the developing immune system","volume":"2","author":"Palmer","year":"2011","journal-title":"Adv. Nutr. Bethesda Md."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1093\/aje\/kwy091","article-title":"Ramadan exposure in utero and child mortality in Burkina Faso: Analysis of a population-based cohort including 41,025 children","volume":"187","author":"Schoeps","year":"2018","journal-title":"Am. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Glazier, J.D., Hayes, D.J.L., Hussain, S., D\u2019Souza, S.W., Whitcombe, J., Heazell, A.E.P., and Ashton, N. (2018). The effect of Ramadan fasting during pregnancy on perinatal outcomes: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-2048-y"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Oosterwijk, V.N.L., Molenaar, J.M., van Bilsen, L.A., and Kiefte-de Jong, J.C. (2021). Ramadan Fasting during Pregnancy and Health Outcomes in Offspring: A Systematic Review. Nutrients, 13.","DOI":"10.3390\/nu13103450"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.earlhumdev.2006.07.001","article-title":"The Dutch famine and its long-term consequences for adult health","volume":"82","author":"Roseboom","year":"2006","journal-title":"Early Hum. Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1093\/ajcn\/84.2.322","article-title":"Early onset of coronary artery disease after prenatal exposure to the Dutch famine","volume":"84","author":"Painter","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"16881","DOI":"10.1073\/pnas.1009459107","article-title":"Prenatal undernutrition and cognitive function in late adulthood","volume":"107","author":"Wouters","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_19","unstructured":"(2021, November 21). CPH\u2019s Data Extraction and Assessment Template. Available online: https:\/\/ph.cochrane.org\/review-authors."},{"key":"ref_20","unstructured":"(2021, November 23). Specialist Unit for Review Evidence (SURE). Available online: https:\/\/www.cardiff.ac.uk\/__data\/assets\/pdf_file\/0006\/1142997\/SURE-CA-form-for-Cohort_2018.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1093\/aje\/kwy132","article-title":"As Long as the Breath Lasts: In Utero Exposure to Ramadan and the Occurrence of Wheezing in Adulthood","volume":"187","author":"Pradella","year":"2018","journal-title":"Am. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1093\/aje\/kwt023","article-title":"Associations of prenatal exposure to Ramadan with small stature and thinness in adulthood: Results from a large Indonesian population-based study","volume":"177","author":"Painter","year":"2013","journal-title":"Am. J. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.jhealeco.2011.07.014","article-title":"Long-term health effects on the next generation of Ramadan fasting during pregnancy","volume":"30","year":"2011","journal-title":"J. Health Econ."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e001185","DOI":"10.1136\/bmjgh-2018-001185","article-title":"Short-term and long-term distributional consequences of prenatal malnutrition and stress: Using Ramadan as a natural experiment","volume":"4","author":"Majid","year":"2019","journal-title":"BMJ Glob. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jdeveco.2015.06.006","article-title":"The persistent effects of in utero nutrition shocks over the life cycle: Evidence from Ramadan fasting","volume":"117","author":"Majid","year":"2015","journal-title":"J. Dev. Econ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.ehb.2018.12.001","article-title":"The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: Evidence from the Indonesian Family Life Survey","volume":"33","author":"Kunto","year":"2019","journal-title":"J. Econ. Hum. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1007\/s10995-021-03154-y","article-title":"The Impact of Prenatal Exposure to Ramadan on Child Anthropomorphic Outcomes in Pakistan","volume":"25","author":"Chaudhry","year":"2021","journal-title":"Matern. Child Health J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1024\/0300-9831.74.5.374","article-title":"Intellectual development of children born of mothers who fasted in Ramadan during pregnancy","volume":"74","author":"Azizi","year":"2004","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e23531","DOI":"10.1002\/ajhb.23531","article-title":"Short-term fetal nutritional stress and long-term health: Child height","volume":"33","author":"Karimi","year":"2021","journal-title":"Am. J. Hum. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1080\/10168737.2020.1811750","article-title":"Does Ramadan Harm Infant Health? Evidence from Ethiopia","volume":"34","author":"Lee","year":"2020","journal-title":"Int. Econ. J."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Almond, D., Mazumder, B., and Van Ewijk, R. (2011). Fasting during Pregnancy and Children\u2019s Academic Performance, National Bureau of Economic Research. 0898-2937.","DOI":"10.3386\/w17713"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.econedurev.2017.07.008","article-title":"Fetal malnutrition and academic success: Evidence from Muslim immigrants in Denmark","volume":"60","author":"Greve","year":"2017","journal-title":"J. Econ. Educ. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ehb.2016.02.002","article-title":"Labor market effects of intrauterine exposure to nutritional deficiency: Evidence from administrative data on Muslim immigrants in Denmark","volume":"21","author":"Tekin","year":"2016","journal-title":"Econ. Hum. Biol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1257\/app.3.4.56","article-title":"Health capital and the prenatal environment: The effect of Ramadan observance during pregnancy","volume":"3","author":"Almond","year":"2011","journal-title":"Am. Econ. J. Appl. Econ."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ehb.2018.05.001","article-title":"The effect of prenatal exposure to Ramadan on children\u2019s height","volume":"30","author":"Karimi","year":"2018","journal-title":"Econ. Hum. Biol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jegh.2016.06.002","article-title":"Predictors of Ramadan fasting during pregnancy","volume":"6","author":"Savitri","year":"2016","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_37","first-page":"181","article-title":"The effect of ramadan fasting on outcome of pregnancy","volume":"20","author":"Ziaee","year":"2010","journal-title":"Iran. J. Pediatr."},{"key":"ref_38","unstructured":"BIMA (2021, November 22). Ramadan Compendium. Available online: https:\/\/britishima.org\/ramadan\/compendium\/."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1093\/jn\/nxaa033","article-title":"Ramadan Is Not the Same As Ramadan Fasting","volume":"150","author":"Seiermann","year":"2020","journal-title":"J. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Quaresima, P., Visconti, F., Interlandi, F., Puccio, L., Caroleo, P., Amendola, G., Morelli, M., Venturella, R., and Di Carlo, C. (2021). Awareness of gestational diabetes mellitus foetal-maternal risks: An Italian cohort study on pregnant women. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-04172-y"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/12\/4511\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:50:17Z","timestamp":1760169017000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/12\/4511"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,17]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["nu13124511"],"URL":"https:\/\/doi.org\/10.3390\/nu13124511","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,17]]}}}