Are pregnant women required to fast?
Muslim jurists generally claim that during the early stages of pregnancy, a woman is required to fast during the holy month of Ramadan, so long as she feels that fasting is not harmful to her health or the health of her unborn child. However, during the more advanced stages of pregnancy, a woman is not required to fast, as to do so may be detrimental to her health and the health of the unborn child. At any stage during pregnancy, if a pregnant woman does not fast, then she is required to make up for each fast she has missed by observing a lapsed (qaḍāʾ) fast, along with paying a compensation, known as fidya. In the event that she is unable to observe the lapsed fasts before the start of the next holy month of Ramadan, she is required to pay a further penalty, known as kafāra, for each lapsed fast.
Pregnant mothers, irrespective of what stage of pregnancy they are at, must not fast without seeking approval from a specialist obstetric team. The requirement of seeking approval also extends to cases of threatened, incomplete, missed, or ectopic miscarriages. At any stage during pregnancy, if a pregnant woman does not fast, then she has to observe a lapsed fast, and if she cannot observe a lapsed fast within a year, then she must pay a compensation known as fidya.
1. The Quran stipulates, “O you who believe, fasting is prescribed for you, as it was prescribed for those before you, so that you may be God-conscious. Fast for a specific number of days, but if you are ill, or on a journey, on other days later. For those who can fast only with extreme difficulty, there is a way to compensate – feed a needy person. But if anyone does good of his own accord, it is better for him, and fasting is better for you, if only you knew.” 
This verse of the Quran clearly excuses any person who suffers from a health condition from observing obligatory fasts during the holy month of Ramadan, and instead prescribes that he or she can fast on another day (outside of the holy month of Ramadan), or feed the needy as compensation for not fasting. However, the general verse of the Quran does not clarify what exactly is meant by “illness” and therefore, it can be interpreted in an unrestricted manner and indicate any kind of physical or mental health condition, which would include the mere fear of developing a health condition due to fasting.
2. There is some level 2 and 3 medical evidence to suggest that pregnancy is, or could be, harmful to an unborn child and the mother regardless of gestational age.
3. There are numerous juristic maxims (qawāʿid al-fiqhiyya) that are derived from the Quran and the traditions of the Prophet and his family that act as meta-legal principles, which support the unrestricted reading of the aforementioned verse of the Quran. Amongst these juristic maxims is the maxim of ‘eliminating harm’ (nafī al-ḍarar). According to this maxim, causing any harm to oneself or to others is prohibited, and therefore if enacting the Sharia obligatory fast will cause harm to a mother or her unborn child, then it is prohibited for her to fast.
4. The verse of the Quran, however, does claim that “fasting is better for you, if only you knew.”  This may give rise to doubt in the mind of a pregnant mother about whether or not she is obligated or prohibited from fasting.
5. In light of the verse of the Quran that states “ask those who know”  it becomes clear that the most qualified group of people who can assess and advise on the level of bearable or unbearable harm that a mother or her unborn child may experience due to fasting is the obstetric team. Accordingly, it is necessary for a pregnant woman to consult her obstetric team prior to the commencement of the holy month of Ramadan.
 Quran 2:183-4
Majid F, Behrman J, Mani S Short-term and long-term distributional consequences of prenatal malnutrition and stress: using Ramadan as a natural experiment BMJ Global Health 2019;4
Medical evidence is classified into a hierarchical system in order to ascertain its reliability and practical use. Physicians are encouraged to find the highest level of evidence to answer clinical questions with 1 being the highest and 5 being the lowest:
Level 1– Systematic review of Randomised Controlled Trials (RCT) in order to remove any bias and collate results to see if they are significant as a cohort.
Level 2– RCT with proper randomisation designed to have very low levels of bias and a low risk of systematic error/confounding factors.
Level 3 Evidence – Well designed cohort or case-control study. This is an example of a comparative study with concurrent controls.
Level 4 Evidence – Comparative study without concurrent controls e.g. historical control study or interrupted time series.
Level 5 Evidence – Case series or expert opinion.
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128(1):305–310
Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989; 95:2S–4S
 Quran 2:184
Quran 21:7, 16:43
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