Impact of prenatal exposure to Ramadan on disability in Pakistan among adults age 18-64.

Purpose: Temporary disruptions to eating and sleeping patterns due to exposure to Ramadan during pregnancy have been shown to increase the probability of disability and chronic health problems later in life. This study aims to analyze the intent-to-treat effect of prenatal exposure to Ramadan (the Islamic month of fasting) on individual disabilities for individuals age 18 to 64 across three provinces encompassing 94% of Pakistan's population.

Subjects And Methods: The study uses observational data from 2017 to 2019 by the UN-supported Multiple Indicator Cluster Survey (MICS) on 187,265 adults in Punjab, 71,895 adults in Sindh, and 91,283 in Khyber Pakhtunkhwa, Pakistan. Excluding data on those age > 64 and observations with incomplete data, multivariate regression analysis was conducted on the data of around 277,000 individuals to assess the risk of disability due to pregnancy coinciding with Ramadan.

Results: Considering exposure to Ramadan by calendar month prior to birth, women exposed in particular months have lower rates of disability related to sight (-0.3 percentage point, < 0.1), memory (-0.3 pp., < 0.05), and mobility (-0.6 pp., p < 0.05) but a higher chance of hearing problems (0.2 pp., p < 0.1) as compared to women who were not exposed in utero, while men exposed in particular months have a higher likelihood of a disability in sight (0.5 pp., < 0.05), hearing (0.4 pp., p < 0.05), communication (0.5 pp., < 0.01), memory (0.5 pp., p < 0.05), or mobility (0.9 pp., p < 0.01) as compared to men who were not exposed to Ramadan and women who were similarly exposed. Considering the provinces separately, the results were dominated by Punjab where overlap of pregnancy with Ramadan increased the likelihood of men experiencing a severe disability in hearing, communication, memory, or mobility. Men in Sindh were more likely to experience a memory or mobility disability, and men in Khyber Pakhtunkhwa were less likely to experience a communication or memory disability.

Conclusions: Pregnant women should be counseled regarding the alterations in eating, nutrition, and sleep patterns that may occur during Ramadan, as exposure to Ramadan during pregnancy increases rates of sight, hearing, memory, communication, and mobility disabilities in men.