Abstract
Giriş
ve Amaç:
Ramazan ayı, yıl içerisinde bir ay süren ve gün doğumu ile gün batımı
arasındaki sürede yemek ve içmenin yasak olduğu oruç tutulan aydır.
Çalışmamızda 2014 yılı Ramazan ayında yaşanan açlık ve susuzluğun, obstetrik B-mod
ve Doppler Ultrasonografi (US) parametrelerine etkisinin olup olmadığını
araştırdık.
Gereç ve Yöntem:
28 Haziran-27 Temmuz 2014 tarihleri arasında obstetrik US istemiyle bölümümüze
başvuran toplam 187 gebe çalışmamıza dahil edildi. Doksan beş gebe oruç tutan
grubu oluştururken, 92 gebe de oruç tutmayan kontrol grubunu oluşturdu. Oruç
tutanların hepsi düzenli sahur ve iftar yapıyordu. Oruç tutan grup, oruçlu
iken, US inceleme saatine göre, 0-8 saat ve 9-16 saat arasında olanlar olmak
üzere iki alt gruba ve tuttuğu gün sayısına göre de, 1-10 gün, 11-20 gün ve
21-30 gün olmak üzere de üç alt gruba ayrıldı. B-mod US bulgularından amniyotik
sıvı indeksi (Aİ), fetal biyometrik ölçümler ve fetal mesane hacmi (FMH)
kaydedildi. Doppler US bulgularından umbilikal arter (UMA), orta serebral arter
(OSA) ve uterin arter (UA), rezistif indeks (Rİ), pulsatilite indeksi (Pİ) ile
sistol/diyastol oranı (S/D) ve umbilikal ven akım (UVA) miktarı saptandı. İki
grup arasında ve belirlenen alt gruplar arasında elde edilen bulgular karşılaştırıldı.
Ayrıca, FMH ile Aİ arasındaki ilişki,
FMH ve Aİ'nin oruç tutulan gün sayısı ile ilişkisi araştırıldı. P<0.05 olduğunda aradaki farkın anlamlı
olduğu kabul edildi.
Bulgular:
Yaş ortalaması oruç tutan grupta 26.9 iken, kontrol grubunda 26.1 idi. İki
grubun tanımlayıcı özellikleri ve gebelik haftaları benzerdi. İki grup arasında B-mod US ve Doppler US
bulguları arasında fark yoktu (p>0.05). Saatlere göre yapılan
karşılaştırmada bulgular arasında anlamlı farklılık tespit edilmedi (p>0.05).
Tutulan gün sayısına göre yapılan karşılaştırmada ise, 1-10 gün arasında US
yapılanlarda 11-20 gün ve 21-30 gün arasında
yapılanlara göre UMA Rİ değerleri daha düşük çıktı (p=0.019).
Karşılaştırılan diğer parametreler arasında fark yoktu. Ayrıca oruç tutulan gün
sayısı ile FMH ve Aİ arasında ilişki saptanmadı. FMH ve Aİ arasında negatif
korelasyon mevcuttu (Spearman’s rho=-0.532,
p<0.001).
Sonuç:
Düzenli sahur ve iftar yapan
gebelerde uzun ve sıcak günlerde oruç tutma; Aİ, FMV, UVA miktarı ve UMA, OSA
ve UA indekslerini değiştirmemekte, ancak oruç tutulan ilk günlerde UMA Rİ azalmaktadır.
References
- 1. Osol G, Mandala M. 2009. Maternal uterine vascular remodeling during pregnancy. Physiology 24:58–71.
- 2. Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. 2008. Effect of fasting during Ramadan on fetal development and maternal health. J Obstet Gynaecol Res 34:494–498.
- 3. Sciscione AC, Hayes EJ. 2009. Uterine artery Doppler flow studies in obstetric practice. Am J Obstet Gynecol 201:121–126.
- 4. Kamyabi Z, Naderi T. 2004. The effect of Ramadan fasting on amniotic fluid volume. Saudi Med J 25:45–46. 5. Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. 2009. The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development. Arch Gynecol Obstet 279:119-123.
- 6. Accuweather, Inc. Weather in July 2014 [Internet data]. Retrieved from http://www.accuweather.com/tr/tr/konya/318795/july-weather/318795.
- 7. Benson CB, Doubilet PM. 2004. Fetal Measurements; Normal and Abnormal Fetal Growth. In: Rumack CM, Wilson SR, Charboneau JW, Johnson JA, editors, Diagnostic Ultrasound. 3rd ed. St. Louis, Missouri: Mosby; 1499–1503.
- 8. Mirghani HM, Salem M, Weerasinghe SD. 2007. Effect of maternal fasting on uterine arterial blood flow. J Obstet Gynaecol Res 33:151–154
- 9. Moradi M. 2011. The effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy. J Res Med Sci 16:165-169.
- 10. Hizli D, Yilmaz SS, Onaran Y, Kafali H, Danişman N, Mollamahmutoğlu L. 2012. Impact of maternal fasting during Ramadan on fetal Doppler parameters, maternal lipid levels and neonatal outcomes. J Matern Fetal Neonatal Med 25:975-977.
- 11. Sakar MN, Gultekin H, Demir B et al. 2015. Ramadan fasting and pregnancy: implications for fetal development in summer season. J Perinat Med 43:319-323. 12. Seckin KD, Yeral MI, Karslı MF, Gultekin IB. 2014. Effect of maternal fasting for religious beliefs on fetal sonographic findings and neonatal outcomes. Int J Gynaecol Obstet 126:123-125. 13. Galan HL, Jozwik M, Rigano S, et al. 1999. Umbilical vein blood flow determination in the ovine fetus: comparison of Doppler ultrasonographic and steady-state diffusion techniques. Am J Obstet Gynecol 181: 1149–1153.
- 14. Ferrazzi E, Rigano S, Bozzo M, et al. 2000. Umbilical vein blood flow in growth-restricted fetuses. Ultrasound Obstet Gynecol 16: 432–438.
- 15. Laurin J, Marsal, Persson PH, Lingman G. 1987. Ultrasound measurement of fetal blood flow in predicting fetal outcome. Br J Obstet Gynaecol 94: 940–948.
- 16. Rigano S, Bozzo M, Ferrazzi E, Bellotti M, Battaglia FC, Galan HL. 2001. Early and persistent reduction in umbilical vein blood flow in the growth-restricted fetus: a longitudinal study. Am JObstet Gynecol 185: 834–838.
- 17. Prior T, Mullins E, Bennett P, Kumar S. 2014. Umbilical venous flow rate in term fetuses: can variations in flow predict intrapartum compromise? Am J Obstet Gynecol 210:61.
- 18. Gilbert WM, Brace RA. 1989. The missing link in amniotic fluid volume regulation: intramembranous absorption. Obstetrics and Gynecology 74:748–754.
- 19. Mirghani HM, Weerasinghe DS, Ezimokhai M, Smith JR. 2003. The effect of maternal fasting on the fetal biophysical profile. Int J Gynaecol Obstet 81:17-21.
The Effect of Ramaddan Fasting in Summer Season on Fetal/Obstetric B-Mode and Doppler Ultrasound Findings
Abstract
Background
and Aim: Ramadan is a
month of religious fasting within a year in which eating and drinking are
prohibited during the time between sunrise and sunset. In our study, we
investigated whether there is an effect of hunger and thirst experienced in the
month of Ramadan in 2014 on obstetric B-mode and Doppler Ultrasound (US)
parameters.
Materials and Methods:
Our study included a total of 187 pregnant women admitted to our department
with the request for obstetric ultrasound between June 28 and July 27, 2014. Ninety-five
pregnant were recorded as the fasting group and 92 pregnant women were recorded
as the non-fasting control group. All of fasting group had sahur (night) and
iftar (evening) meals regularly. The fasting group was divided into two
sub-groups based on the time of ultrasound examination during the day of
fasting (between 0-8 hours and 9-16 hours) and three sub-groups according to
the number of fasting days (1-10 days, 11-20 days and 21-30 days). Among B-mode
ultrasound findings, we recorded amniotic fluid index (AFI), fetal biometric
measurements and fetal bladder volume (FBV). Furthermore, we evaluated Doppler
ultrasound findings including the resistive index (RI), pulsatility index (PI)
and systolic/diastolic ratio (S/D) of umbilical artery (UmA), middle cerebral
artery (MCA) and uterine artery (UA), and the value of umbilical vein flow
(UVf). These findings were compared between two main groups and the subgroups. In
addition, we investigated the correlation between FBV and AFI and the
relationship of FBV and AFI with the number of fasting days. A p-value of <0.05 showed a statistically
significant difference.
Results: The mean age was 26.9 years
and 26.1 years in the fasting and control groups, respectively. Descriptive characteristics
and gestational age were similar between the two groups. Likewise, B-mode and
Doppler ultrasound findings did not differ between the two groups (p > 0.05).
No significant difference was observed in the comparison according to the time
of ultrasound examination (p > 0.05). In the comparison made according to
the number of fasting days, the resistive index (RI) of the umbilical artery
(UMA) was higher in the sub-group of 1-10 days compared to the group of 11-20
days and 21-30 days (p = 0.019). However, there was no significant difference
between other parameters. In addition, there was no correlation between the
number of fasting days and FBV and AFI. Moreover, there was a negative
correlation between FBV and AFI (Spearman’s
rho=-0.532, p<0.001).
Conclusion: In pregnant
women who had sahur and iftar meals regularly, Ramadan fasting during long and
hot days did not significantly alter AFI, FBV, value of umbilical vein flow
(UVf), and indexes of umbilical artery (UMA) middle cerebral artery (MCA) and
uterine artery (UA), but fasting decreased UMA RI in the early days.
References
- 1. Osol G, Mandala M. 2009. Maternal uterine vascular remodeling during pregnancy. Physiology 24:58–71.
- 2. Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. 2008. Effect of fasting during Ramadan on fetal development and maternal health. J Obstet Gynaecol Res 34:494–498.
- 3. Sciscione AC, Hayes EJ. 2009. Uterine artery Doppler flow studies in obstetric practice. Am J Obstet Gynecol 201:121–126.
- 4. Kamyabi Z, Naderi T. 2004. The effect of Ramadan fasting on amniotic fluid volume. Saudi Med J 25:45–46. 5. Dikensoy E, Balat O, Cebesoy B, Ozkur A, Cicek H, Can G. 2009. The effect of Ramadan fasting on maternal serum lipids, cortisol levels and fetal development. Arch Gynecol Obstet 279:119-123.
- 6. Accuweather, Inc. Weather in July 2014 [Internet data]. Retrieved from http://www.accuweather.com/tr/tr/konya/318795/july-weather/318795.
- 7. Benson CB, Doubilet PM. 2004. Fetal Measurements; Normal and Abnormal Fetal Growth. In: Rumack CM, Wilson SR, Charboneau JW, Johnson JA, editors, Diagnostic Ultrasound. 3rd ed. St. Louis, Missouri: Mosby; 1499–1503.
- 8. Mirghani HM, Salem M, Weerasinghe SD. 2007. Effect of maternal fasting on uterine arterial blood flow. J Obstet Gynaecol Res 33:151–154
- 9. Moradi M. 2011. The effect of Ramadan fasting on fetal growth and Doppler indices of pregnancy. J Res Med Sci 16:165-169.
- 10. Hizli D, Yilmaz SS, Onaran Y, Kafali H, Danişman N, Mollamahmutoğlu L. 2012. Impact of maternal fasting during Ramadan on fetal Doppler parameters, maternal lipid levels and neonatal outcomes. J Matern Fetal Neonatal Med 25:975-977.
- 11. Sakar MN, Gultekin H, Demir B et al. 2015. Ramadan fasting and pregnancy: implications for fetal development in summer season. J Perinat Med 43:319-323. 12. Seckin KD, Yeral MI, Karslı MF, Gultekin IB. 2014. Effect of maternal fasting for religious beliefs on fetal sonographic findings and neonatal outcomes. Int J Gynaecol Obstet 126:123-125. 13. Galan HL, Jozwik M, Rigano S, et al. 1999. Umbilical vein blood flow determination in the ovine fetus: comparison of Doppler ultrasonographic and steady-state diffusion techniques. Am J Obstet Gynecol 181: 1149–1153.
- 14. Ferrazzi E, Rigano S, Bozzo M, et al. 2000. Umbilical vein blood flow in growth-restricted fetuses. Ultrasound Obstet Gynecol 16: 432–438.
- 15. Laurin J, Marsal, Persson PH, Lingman G. 1987. Ultrasound measurement of fetal blood flow in predicting fetal outcome. Br J Obstet Gynaecol 94: 940–948.
- 16. Rigano S, Bozzo M, Ferrazzi E, Bellotti M, Battaglia FC, Galan HL. 2001. Early and persistent reduction in umbilical vein blood flow in the growth-restricted fetus: a longitudinal study. Am JObstet Gynecol 185: 834–838.
- 17. Prior T, Mullins E, Bennett P, Kumar S. 2014. Umbilical venous flow rate in term fetuses: can variations in flow predict intrapartum compromise? Am J Obstet Gynecol 210:61.
- 18. Gilbert WM, Brace RA. 1989. The missing link in amniotic fluid volume regulation: intramembranous absorption. Obstetrics and Gynecology 74:748–754.
- 19. Mirghani HM, Weerasinghe DS, Ezimokhai M, Smith JR. 2003. The effect of maternal fasting on the fetal biophysical profile. Int J Gynaecol Obstet 81:17-21.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Original article |
| Authors | |
| Publication Date | March 15, 2018 |
| Published in Issue | Year 2018 Volume: 10 Issue: 1 |
e-ISSN: 2548-0251
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