2%) to start with Most of the women were able to successfully un

2%) to start with. Most of the women were able to successfully undergo Ramadan fasting for more than 15 days, with a median of 25 days in each group. One patient, who was in her third trimester, fasted only for two days, since she felt tired Quizartinib in vivo during the fasting days. There were no hypoglycemic events in these women. Since majority of the participating women had T2DM, the combined regimen of insulin (short-acting and intermediate-acting) was mostly used. Intermediate-acting insulin was added to short-acting Inhibitors,research,lifescience,medical insulin if the fasting hyperglycemia remained a problem. Similar insulin injections were given to fasting non pregnant women

with T2DM needing insulin therapy in a previous study.8 In the present study, the insulin injections were given at pre dawn meal and prior to sunset meal, similar to guidelines Inhibitors,research,lifescience,medical advocated and recommended for non pregnant patients.8,13 Despite scarcity of published studies on Ramadan fasting

in pregnant women, earlier studies,3,4 showed that mild dehydration did not lead to adverse effect on intrauterine fetal development in healthy pregnant women. Moreover, it was observed that maternal blood glucose level was significantly reduced.3,4,14 A similar findings were observed in the present study, where there was no deterioration in the glycemic control, and a significance proportion of women were still able to achieve the glycemic targets. Inhibitors,research,lifescience,medical However, post prandial monitoring, which could have a better assessment of the hyperglycemic state, was not undertaken. During Ramadan fasting, the patients fasted for 4 weeks at the most. Comparing Inhibitors,research,lifescience,medical such a period to the rest of non fasting days in the remaining 34 weeks of pregnancy, during

which regular meals with more caloric are taken, one would expect a worse or more challenging hyperglycemia to occur during the non fasting days. Dikensoy et al in their studies,3,4 compared healthy pregnant women who fasted during Ramadan with those who did not, and showed that maternal glucose levels Inhibitors,research,lifescience,medical were significantly lower in the fasting group. Another study assessing placenta sizes in normally-pregnant women, however, showed that the mean placental weight was lower in those whose mothers were fasting.15 Nonetheless the overall long term effect on children whose diabetic mothers fast during pregnancy has out not been studied yet. In another study by Malhotra et al.14 on Asian pregnant mothers fasting during Ramadan, it was shown that babies born to mothers who had fasted during Ramadan had a mean birth weights similar to birth weights of similar children in Europe. Thus, the only immediate and major fetal event namely fetal death, which may be a limitation of the present study, was considered. It is proposed to repeat the present study with a larger sample size looking at the overall pregnancy results, condition of placenta and the outcomes of neonates.

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