BACKGROUND Intermittent fasting, such as during Ramadan, is prevalent among pregnant women. However, the association between Ramadan during pregnancy and offspring health along the life course has not been fully established. OBJECTIVE AND RATIONALE Fetal programming research indicates that prenatal exposures, particularly during early pregnancy, can cause long-term structural and physiological changes that adversely affect offspring health. Our objective was to systematically identify and assess the evidence regarding Ramadan during pregnancy. SEARCH METHODS A total of 31 studies were sourced from PubMed, EMBASE, Web of Science, and EconLit. Included studies evaluated outcomes in individuals with prenatal Ramadan exposure, compared to unexposed Muslim controls. Main outcomes were birth weight, gestational length, and sex ratio in newborns; height, mortality, and cognition in children; and disabilities, chronic diseases, and human capital accumulation in adults. Each study was evaluated for risk of bias. The overall quality of evidence was appraised using the GRADE system. Random-effects meta-analyses were conducted for outcomes analyzed in at least three primary studies. OUTCOMES The initial search identified 2933 articles, 1208 duplicates were deleted. There were 31 publications fulfilled the eligibility criteria for the qualitative synthesis; 22 studies were included in meta-analyses. The overall quality of the evidence was low to moderate and differed by study design and outcome. Among newborns, prenatal Ramadan exposure was not associated with birth weight (mean difference (MD) -3 g (95% CI -18 to 11; I2 = 70%) or the likelihood of prematurity (percentage point difference (PPD) 0.19 (95% CI -0.11 to 0.49; I2 = 0%)). The probability that the newborn is male was reduced (PPD -0.14 (95% CI -0.28 to -0.00; I2 = 0%)). This potentially reflects sex-specific mortality rates resulting from adverse in utero circumstances. In childhood, the exposed performed slightly poorer on cognitive tests (MD -3.10% of a standard deviation (95% CI -4.61 to -1.58; I2 = 51%)). Height among the exposed was reduced, and this pattern was already visible at ages below 5 years (height-for-age z-score MD -0.03 (95% CI -0.06 to -0.00; I2 = 76%)). A qualitative literature synthesis revealed that childhood mortality rates were increased in low-income contexts. In adulthood, the prenatally exposed had an increased likelihood of hearing disabilities (odds ratio 1.26 (95% CI 1.09 to 1.45; I2 = 32%)), while sight was not affected. Other impaired outcomes included chronic diseases or their symptoms, and indicators of human capital accumulation such as home ownership (qualitative literature synthesis). The first trimester emerged as a sensitive period for long-term impacts. WIDER IMPLICATIONS Despite the need for more high-quality studies to improve the certainty of the evidence, the synthesis of existing research demonstrates that Ramadan during pregnancy is associated with adverse offspring health effects in childhood and especially adulthood, despite an absence of observable effects at birth. Not all health effects may apply to all Muslim communities, which are diverse in backgrounds and behaviors. Notably, moderating factors like daytime activity levels and dietary habits outside fasting hours have hardly been considered. It is imperative for future research to address these aspects. REGISTRATION NUMBER PROSPERO (CRD42022325770).

中文翻译：

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怀孕期间的斋月和后代生命过程中的健康结果：系统评价和荟萃分析。


背景 间歇性禁食，例如在斋月期间，在孕妇中很普遍。然而，怀孕期间的斋月与后代在生命过程中的健康之间的关联尚未完全确定。客观和基本原理 胎儿编程研究表明，产前暴露，尤其是在怀孕早期，会导致长期的结构和生理变化，从而对后代健康产生不利影响。我们的目的是系统地识别和评估有关怀孕期间斋月的证据。检索方法 共有 31 项研究来自 PubMed、EMBASE、Web of Science 和 EconLit。纳入的研究评估了与未暴露的穆斯林对照相比，产前斋月暴露个体的结局。主要结局是新生儿出生体重、胎长和性别比;儿童的身高、死亡率和认知能力;以及成人的残疾、慢性病和人力资本积累。每项研究都评估了偏倚风险。使用 GRADE 系统评价证据的总体质量。对至少 3 项主要研究中分析的结局进行了随机效应荟萃分析。结果 初步检索确定了 2933 篇文章，删除了 1208 篇重复文章。有 31 篇出版物符合定性综合的合格标准;22 项研究被纳入荟萃分析。证据的总体质量为低到中等，并且因研究设计和结局而异。在新生儿中，产前斋月暴露与出生体重无关（平均差 （MD） -3 g（95% CI -18 至 11;I2 = 70%）或早产可能性（百分点差异 （PPD） 0.19 （95% CI -0.11 至 0.49;I2 = 0%））。 新生儿为男性的概率降低（PPD -0.14 （95% CI -0.28 至 -0.00;I2 = 0%））。这可能反映了子宫内不良环境导致的性别特异性死亡率。在儿童时期，暴露者在认知测试中的表现略差（MD -3.10% 为标准差（95% CI -4.61 至 -1.58;I2 = 51%））。暴露者的身高降低，这种模式在 5 岁以下已经可见（年龄别身高 z 评分 MD -0.03 （95% CI -0.06 至 -0.00;I2 = 76%））。定性文献综合显示，在低收入环境中，儿童死亡率增加。在成年期，产前暴露者发生听力障碍的可能性增加（比值比 1.26 （95% CI 1.09 至 1.45;I2 = 32%）），而视力不受影响。其他受损结局包括慢性病或其症状，以及人力资本积累的指标，如房屋所有权（定性文献综合）。孕早期成为长期影响的敏感期。更广泛的影响 尽管需要更多高质量的研究来提高证据的质量，但现有研究的综合表明，怀孕期间的斋月与儿童期，尤其是成年期的不良后代健康影响有关，尽管在出生时没有可观察到的影响。并非所有的健康影响都适用于所有穆斯林社区，这些社区的背景和行为各不相同。值得注意的是，几乎没有考虑过白天活动水平和禁食时间以外的饮食习惯等调节因素。未来的研究必须解决这些方面。注册号 PROSPERO （CRD42022325770）。