No evidence for an association between in utero Ramadan exposure and mean arterial pressure and random blood glucose in adulthood: evidence from SEACO in Malaysia

A growing body of evidence shows an association between in utero Ramadan exposure and negative long-term consequences. Nonetheless, there is a scarcity of studies utilizing clinical measures in adults. This study investigates a possible association between in utero Ramadan exposure and mean arterial pressure (MAP) as well as random blood glucose (RBG) measures in the adult offspring. Using cross-sectional data from the Southeast Asia community observatory health and demographic surveillance system (SEACO) in Malaysia for two survey rounds (year 2013 and 2018), we compared MAP and RBG of in utero Ramadan-exposed Muslims with unexposed Muslims and non-Muslims. In utero Ramadan exposure was estimated based on the overlap between pregnancy (estimated from birth dates) and Ramadan periods. We conducted difference-in-differences analyses adjusted for age and birth months (seasonal effects). A total of 20,575 participants aged 35 or older were included in the analysis, comprising 12,696 Muslims and 7,879 non-Muslims. Difference-in-differences analyses revealed no statistically significant association between in utero Ramadan exposure and MAP, or between in utero Ramadan and RBG. These findings persisted in additional analyses examining the timing of Ramadan exposure during pregnancy.