Abstract
Background:
Date palm fruits (Phoenix dactylifera L.) are a widely available product that contains numerous macronutrients including a high sugar content. Research has shown that date fruit extracts possess antibacterial and antifungal properties, as well as antimutagenic and antiatherogenic effects. Date fruit can also have a beneficial effect on the female reproductive system. Several studies have examined the impact of date consumption during pregnancy on the outcome of labor, providing useful results.
Objective:
This study aims to determine the effects of date fruit consumption on the onset and progression of labor.
Methods:
The study included 120 pregnant women who were pregnant at GAK Sarajevo, in the period from 01.01. 2020 to 31.12. 2020. The patients were divided into two groups, the first group of 60 patients who consumed 6 dates during the last four weeks of pregnancy, and the second group of 60 patients who did not consume dates during pregnancy.
Results:
There was a significant positive effect of consuming date fruits on maternal outcomes in the first and third stages of labor. The group of pregnant women who consumed dates had a shortened latent phase of labor, which meant that their cervix reached maximum dilation (10 cm) faster. Pregnant women in this group gave birth 8.5 hours faster than pregnant women who did not consume dates, in whom labor lasted about 15 hours. Of the 60 pregnant women in the first group, 60% had a spontaneous natural birth, and only 40% of the patients received oxytocin, because dates enhance the effect of oxytocin, which is responsible for uterine contractions.
Conclusion:
This study showed a promising effect of consuming date fruits on the duration of the stages of labor. Saturated and unsaturated fatty acids found in dates stimulate the production of prostaglandins, which are necessary for labor. Dates are also rich in folic acid, vitamin K, iron, potassium, and magnesium.
Keywords: date, effect, pregnant woman, childbirth, dilation, oxytocin
1. BACKGROUND
In the holy Quran, the holy book of Islam, Allah instructs the Virgin Mary, Mariam, to consume date fruits when she gives birth to prophet Isa; peace will be upon him as well as the prophet Mohammed (And shake toward you the trunk of the palm tree; it will drop upon you ripe, fresh dates) (1). Therefore, not surprisingly, date fruits are commonly referred within the Islamic tradition as beneficial to pregnant women. We might use this as a ‘pre-scientific’ magical background to assess the effects of date fruit consumption on the onset until the final stage of labour. The date fruit (Phoenix dactylifera) appears to be a reasonable food choice for pregnant women as a part of a well-balanced diet. It contains a high percentage of carbohydrate, fat, 15 types of salts and minerals, proteins, and vitamins (2).
The saturated and unsaturated fatty acids, such as oleic and linoleic acids, in date fruits play an essential part in the production of prostaglandins apart from contributing and providing energy (3). The increase in the levels of the latter in pregnant women causes uterine contractions during term (4).
Therefore, date fruit consumption can be helpful in saving energy and strengthening the uterine muscles. This fruit also contains hormones that help the uterus stretch and be prepared for infant delivery (5). Its consumption is helpful in storing energy and strengthening the uterine muscles (6).
Thus, it prevents postpartum haemorrhage, spontaneous labour, and speeding up of the delivery progress. According to Kordi et al. and Yusefy et al., consuming date fruits in late pregnancy has a significant role in spontaneous labour (7). Al-Kuran et al. reported that the duration of the latent phase of the first stage of labour was shorter in the group that consumed date fruits and that the average cervical dilation at the time of admission was significantly higher than that in the group that consumed date fruits (6). Date fruits affect oxytocin receptors and make the uterine muscles respond better to oxytocin, resulting in much more effective uterine contractions (8).
The consumption of date fruits in late pregnancy has favourable results in shortening labour stages, without influencing labour outcomes. In a Jordanian study, the effect of late pregnancy consumption of date fruits on labour and delivery was determined starting from late weeks of pregnancy; a comparison between the two groups showed significant outcomes in cervical dilatation on admission, status of the amniotic membranes, type of onset of labour, and less need for prostin/oxytocin utilisation. The study had concluded that the consumption of date fruits in the last 4 weeks before labour significantly reduced the need for induction and augmentation of labour and yielded a more favourable, but non-significant, delivery outcome (6).
The consumption of date palm fruit (DPF), commonly named dates, is a typical behavior among women from the Middle East during the final month of gestation (9). In different traditional medicines, DPF is also highly recommended to be consumed by parturients and breastfeeding mothers (10).
Likewise, based on Islamic narrations and verses of the holy Quran (the leading Islamic religious book), eating DPF is favorably proposed in late pregnancy and labor for safe childbirth and promoting maternal and neonatal health (11).
The DPF has substantial fructose, glucose, tannins, serotonin, linoleic and linolenic fatty acids, calcium, iron, potassium, magnesium, estrogen, progesterone, potuchsin hormone, and oxytocin-like agents. These ingredients all cause satisfactory childbirth and perinatal outcomes, including but not limited to strengthening maternal energy, stimulating the uterine muscle contractions, accelerating the spontaneity of labor and uterine involution process, declining labor pain, facilitating placental abruption, increasing parturients’ hemoglobin (Hb) levels and controlling their blood pressure, reducing PPH, and boosting the mother’s breast milk production (12).
Despite the scientific rationale behind the beneficial effects of eating DPF in peripartum, some trials do not robustly support this practice. It was reported that maternal cervical dilatation (CD); delivery mode; and/or the score of neonatal appearance, pulse, grimace, activity, and respiration (APGAR) did not significantly change between parturients who ingested DPF in late pregnancy or labor and those who only received routine obstetric and nursing care (13).
Besides, no substantial differences were reported in the length of labor stages between the dates consumption and control groups (14,15,16).
Further, the efficacy of using DPF on labor bleeding or PPH was similar to standard care. Also, there was no significant increase in maternal’ Hb levels after daily consumption of DPF. In addition to trials, recent systematic reviews or meta-analyses have reported contradicting findings on the usefulness of consuming DPF in late pregnancy or labor (20,21,22). Previous studies mainly limited the publication’s searches regarding databases, languages, or locations; thus, they have missed several related trials. Additionally, the last corresponding systematic review with meta-analysis screened publications up to August 2019 (20) however, some relevant studies have been published since then.
2. OBJECTIVE
Therefore, by performing a comprehensive search in different appropriate data sources, this updated systematic review aimed to summarize and statistically pool the results of all available non-randomized and randomized controlled trials (RCTs) published in any language regarding the effects of oral intake of DPF in the peripartum period on childbirth progress and perinatal outcomes.
3. MATERIAL AND METHODS
The research was conducted at the Department of Gynecology and Obstetrics of the Clinical Center of the University of Sarajevo. This is a retrospective study. The study included 120 pregnant women who were pregnant at GAK Sarajevo, in the period from 01.01. 2020 to 31.12. 2020. The patients were divided into two groups, the first group of 60 patients who consumed 6 dates during the last four weeks of pregnancy, and the second group of 60 patients who did not consume dates during pregnancy. Descriptive analysis was applied to process demographic data, clinical characteristics and pregnancy outcomes, presented as percentages, means and standard deviations.
4. RESULTS
The research is based on a retrospective study that included 120 patients who were hospitalized at the Clinic for Gynecology and Obstetrics at the Clinical Center of the University of Sarajevo, in the period from January 1, 2020. until 31.12.2020. year. Of the total number of pregnant women, 60 patients consumed 6 dates per day during the last 4 weeks of their pregnancy, while 60 patients did not consume dates.
In the research participated 35 (58.4%) first-time mothers, 17 second-time mothers (28.30%), and 8 third-time mothers (13.30%). Among first-born women, the most were 5 cm open, 23 of them (65.70%), and also among second-born women, 14 (82.40%) were open 5 cm among mothers who consumed dates. In third-birth mothers, 5 of them were 6 cm dilated, and 3 of them were 4 cm dilated. There is a larger number of women in labor who gave birth without induction, 60% of them.
Of the 60 patients who consumed dates, 36 (60%) gave birth naturally vaginally, while 24 (40%) received oxytocin. Of the 24, 7 had a caesarean section, 3 were delivered by vacuum, and 14 (23.3%) had an episiotomy. In patients who did not consume dates, the dilation phase is longer by 1.5 to 2 hours. The group of pregnant women who consumed dates had a shortened latent phase of labor, which meant that their cervix reached maximum dilation (10 cm) faster.
Table 1. Basic and clinical characteristics of the study groups.
| Frequency | Percentage | |
|---|---|---|
| Number of births | ||
| First- time mothers | 35 | 58,40 % |
| Second- time mothers | 17 | 28,30 % |
| Third- time mothers | 8 | 13,30 % |
| First- time mothers | ||
| open 5 cm | 23 | 65,70 % |
| 3 cm | 8 | 22,90 % |
| 1 cm | 2 | 5,70 % |
| Second- time mothers | ||
| 5 cm | 14 | 82,40 % |
| 3 cm | 3 | 17,60 % |
| Third- time mothers | ||
| 6 cm | 5 | 62,50 % |
| 4 cm | 3 | 37,50 % |
| Method of delivery | ||
| Without induction | 36 | 60,00 % |
| Induction | 24 | 40,00 % |
Pregnant women in this group gave birth 8.5 hours faster than pregnant women who did not consume dates, whose labor lasted about 15 hours.
Of the 60 pregnant women in the first group, 60% had a spontaneous natural birth, and only 40% of the patients received oxytocin, because dates enhance the effect of oxytocin, which is responsible for uterine contractions. Saturated and unsaturated fatty acids found in dates stimulate the production of prostaglandins, which are necessary for labor. Also, dates are rich in folic acid, vitamin K, iron, potassium, and magnesium.
The cervical dilatation at baseline was 4.04 ± 1.94 cm (median ± IQR: 4.0 ± 1.75) among the patients who consumed date fruits. Table 3 illustrates the cervical dilatation progression among the participants.
Table 3. Labour progression and foetal outcomes in the study groups.
| Factors | Date fruit consumers |
|---|---|
| Cervical dilatation (hour 0) | |
| Min—max | 0—7 |
| Mean ± SD | 4.04 ± 1.940 |
| Median ± IQR | 4.0 ± 1.75 |
| Cervical dilatation (hour 1) | |
| Min—max | 0—10 |
| Mean ± SD | 5 ± 2.47 |
| Median ± IQR | 5 ± 2 |
| Cervical dilatation (hour 2) | |
| Min—max | 0—10 |
| Mean ± SD | 6.46 ± 2.72 |
| Median ± IQR | 6.50 ± 4.50 |
| Cervical dilatation (hour 3) | |
| Min—max | 0—10 |
| Mean ± SD | 7.58 ± 3.17 |
| Median ± IQR | 10 ± 5.50 |
| Cervical dilatation (hour 4) | |
| Min—max | 0—10 |
| Mean ± SD | 7.96 ± 3.04 |
| Median ± IQR | 10 ± 4 |
| Duration of the stage of labour | |
| First stage | |
| Min—max | 10—660 |
| Mean ± SD | 210.14 ± 177.13 |
| Median ± IQR | 170 ± 310 |
| Second stage | |
| Min—max | 3—99 |
| Mean ± SD | 23.59 ± 23.73 |
| Median ± IQR | 17.50 ± 25.75 |
| Third stage | |
| Min—max | 1—20 |
| Mean ± SD | 5.45 ± 4.50 |
| Median ± IQR | 4 ± 6 |
| Membrane rupture | |
| Min—max | 2—33 |
| Mean ± SD | 9.50 ± 9.79 |
| Median ± IQR | 6.0 ± 9.0 |
| Uterine contractions | |
| Min—max | 0—370 |
| Mean ± SD | 103.20 ± 123.42 |
| Median ± IQR | 50 ± 110 |
| Estimated blood loss amount (ml) | |
| Min—max | 100—600 |
| Mean ± SD | 302.27 ± 126.75 |
| Median ± IQR | 300 ± 212.50 |
| APGAR score at 1 min | |
| Min—Max | 1—9 |
| Mean ± SD | 7.77 ± 2.02 |
| Median ± IQR | 9 ± 3 |
| APGAR score at 5 min | |
| Min—max | 5—10 |
| Mean ± SD | 9.20 ± 1.36 |
| Median ± IQR | 10 ± 1 |
The duration of the first stage of labour was 210.14 ± 177.13, 224.43 ± 157.25, and 362.46 ± 292.12 min in the patients who consumed date fruits and date fruits followed by water and controls, respectively. The duration of the different stages of labour is also shown in Table 2.
Table 2. Labour outcomes and foetal well-being factors.
| Factors | Frequency (n) | Percentage (%) |
|---|---|---|
| Spontaneous vaginal delivery | 36 | 60,00 |
| Caesarean delivery | 7 | 11,7 |
| Vacuum extract | 3 | 5,00 |
| Episiotomy | 14 | 23,3 |
| Oxytocin | 24 | 40,0 |
Table 2 also illustrates the time of membrane rupture (103.20 ± 123.42 min in the patients who consumed date fruits, 168.05 ± 145.58 min in those who consumed date fruits followed by water, and 172.26 ± 169.10 min in the controls). The frequency of uterine contractions was higher among the patients who consumed date fruits only than among those who consumed date fruits followed by water (9.50 ± 9.79 contractions/hour vs. 4.38 ± 3.96 contractions/hour).
Spontaneous vaginal, instrumental, and caesarean deliveries were reported in 48.19%, 3.61%, and 4.82%, respectively, while normal foetal presentation was observed in 98.82%; liquor or blood-stained meconium was observed in 31.77%.
5. DISCUSSION
A study by Al Kuran et al. (2011), which evaluated the effects of date fruit on labor and delivery in nulliparous and multiparous women, showed that the mean cervical dilation at admission in the date fruit group was higher than that in the control group (P<0.005) (6).
Also, in the Al Kuran study, the incidence of spontaneous labor was lower in the intervention group and these women required less induction of labor. They observed that date fruit likely affected oxytocin receptors, causing more effective contractions and better preparing the cervix for labor (6).Of the 60 patients who consumed dates, 36 (60%) gave birth naturally vaginally, while 24 (40%) received oxytocin. Of the 24, 7 had a caesarean section, 3 were delivered by vacuum, and 14 (23.3%) had an episiotomy. In patients who did not consume dates, the dilation phase is longer by 1.5 to 2 hours. The group of pregnant women who consumed dates had a shortened latent phase of labor, which meant that their cervix reached maximum dilation (10 cm) faster.
Pregnant women in this group gave birth 8.5 hours faster than pregnant women who did not consume dates, whose labor lasted about 15 hours.
Of the 60 pregnant women in the first group, 60% had a spontaneous natural birth, and only 40% of the patients received oxytocin, because dates enhance the effect of oxytocin, which is responsible for uterine contractions. Saturated and unsaturated fatty acids found in dates stimulate the production of prostaglandins, which are necessary for labor. Also, dates are rich in folic acid, vitamin K, iron, potassium, and magnesium.
Iravani i sur. (2006) proveli su istraživanje s ciljem utvrđivanja učinkovitosti i sigurnosti ricinusovog ulja u sazrijevanju vrata maternice i indukciji poroda. Prema rezultatima, spontani porođajni bol i srednji Bishopov rezultat bili su značajno viši u intervencijskoj skupini u usporedbi s kontrolnom skupinom (P<0,001); zapravo, ricinusovo ulje, slično datulji, sadrži tvari koje mogu pojačati sintezu prostaglandina (23).
In a case—control study7 conducted in Jordan, in which 69 pregnant women who consumed six pieces of date fruits daily for 4 weeks were compared to controls who consumed no date fruits, the duration of the latent phase of the first stage was shorter in the date fruit consumers, which is in line with the current findings. A short duration of the first and third stages of labour was also found in a recent clinical trial conducted on 91 women who consumed 70—76 g of date fruits from the 37th gestational week, supporting the current findings (24). Another previous study7 observed a higher cervical dilatation and intact membranes among date fruit consumers in contrast to the present observation. The number of pieces, duration of consumption, dryness, and type of the date fruits consumed could explain the differences between the two studies. A higher mean cervical dilatation among date fruit consumers was found in the study by Kuran et al. (6) their findings are not in agreement with those in the current study. A plausible explanation could be the different numbers of pieces of date fruits consumed. Kuran and colleagues used 70—75 g of date fruits from the 37th gestational week until delivery; in the current study, seven pieces of date fruits at the onset of labour were given. Several mechanisms have been proposed for the effect of date fruit consumption on labour progression, including the influence on oxytocin receptors, better cervical preparation, and reinforcement of prostaglandin synthesis (23). Date fruits have anti-oxidant and anti-inflammatory properties and are rich in calcium, which may contribute to the contraction of the smooth muscle of the uterus (25). Furthermore, they are known to contain 15 types of salts and minerals, in addition to high percentages of vitamins, carbohydrates, and fat. It is hypothesised that date fruits stimulate the uterine muscle to respond more favourably to oxytocin, thus preparing the uterus and cervix for delivery.
6. CONCLUSION
The date fruit has been shown to possess several health benefits. Cervical ripening was more favorable in women who consumed dates compared to the group that did not consume them. The date fruit contains 13 vital substances and 5 types of vitamins, fatty acids and sugars. Therefore, this fruit, which is rich in minerals, is recommended for pregnant women who need energizing and nutritious food. Dates also affect the hormones estrogen and progesterone, which are effective in preparing the uterus and ripening the cervix. Since the date fruit is an energizing and nutritious substance, its use is recommended for pregnant women during pregnancy, especially during the last weeks of pregnancy.
Author’s contribution:
The all authors were involved in all steps of preparation this article. Final proofreading was made by the first author.
Conflict of interest:
None to declare.
Financial support and sponsorship:
No specific funding was received for this study.
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