Q: Some of my patients have been eating date fruits for their reported beneficial effects during labor and delivery. Does research support this practice?
Brook Murray, BSN, RN, and Bridget Parsh, EdD, CNS, RN, respond-Interest in the impact of date fruit consumption on labor and delivery outcomes has been increasing in recent years.1,2 Date fruit (Phoenix dactylifera L.) is a staple in many cultures because of its beneficial properties.
The mechanism of action of dates during childbirth is not well understood, but there have been several hypotheses of their benefits.3 Date fruits contain significant amounts of serotonin, tannins, prostaglandins, and other beneficial components that produce successful outcomes in parturition.
Serotonin is commonly referred to as the "happy hormone," but it performs various functions throughout the body.4 Serotonin helps with bowel function, mood regulation, sleep, bone health, coagulation, and sexual function.4 Serotonin has also been found to play a role in stimulating smooth muscle contraction.1 Activation of the uterine smooth muscle, or myometrium, is responsible for the contractions felt during labor.5
Abnormal progress of labor and ineffective contractions are two common reasons for Cesarean section. The active phase of labor, cervical dilation from 6 cm to 10 cm, was significantly shorter in those that consumed six to seven dates beginning at 37 weeks gestation, a mean of 329 minutes, compared with 547.8 minutes for their control group.6 The more effective the uterine contractions, the quicker the cervix prepares for birth by softening and dilating.1,6
Tannins, effective astringents that can control bleeding, are also present in dates.7 Dates have been shown to be more effective at reducing postpartum bleeding than oxytocin, with a total of 162.5 mL for those eating 50 g of dates, approximately two whole dates immediately after delivery of the placenta, and 220.7 mL of blood loss for women getting an injection of 10 units of oxytocin.8
Prostaglandins are thought to be one of the driving forces behind the development of uterine contractions.9 Date fruits contain fatty acids essential to producing prostaglandins, and dates are believed to act on prostaglandin receptors.1 The date fruit effect on prostaglandin receptors can produce timely stimulation of contractions and enhance the response to endogenous and exogenous oxytocin if required.1,2
Some studies have shown a significant increase in the rate of the spontaneous start of labor and a reduction in the need for augmentation in women who consumed date fruit late in pregnancy.6,10 For example, Kordi et al.6 found that 94.5% of the study's date fruit group, who consumed six to seven dates per day beginning at 37 weeks of gestation, experienced a spontaneous start of labor compared with 41.3% of the control group. Another study by Razali et al.10 found that 37% of the date fruit group who consumed seven dates per day beginning at 36 weeks gestation required labor augmentation, while 50% of the control group needed augmentation.
Other beneficial components
Dates are abundant in calcium (39 mg per 100 g of dates), which helps restore calcium levels and contributes to the contraction of the myometrium.2,3 The calcium combined with serotonin, tannins, and prostaglandins helps to make uterine contractions more efficient during fetal descent, cervical dilation, and effacement.11 The efficiency of uterine contractions is thought to decrease the time spent in the first stage of labor.2 This decreased first stage is believed to explain the better APGAR scores at 5 minutes of newborns born to mothers who consumed seven pieces of Rotana rutab dates after admission to the hospital and before delivery.2
The antioxidant and antimicrobial properties of date fruit have resulted in them being beneficial in managing oxidative stress-related and infectious diseases.3 These properties are attributed to the high concentration of phenolic compounds found in the fruit.3 Some studies have shown antibacterial and anti-inflammatory activity attributable to dates.2,3 Some researchers have hypothesized that this antibacterial activity could improve immunity to protect against infection once the membranes have ruptured.12 The anti-inflammatory activity of dates has been shown to significantly lower the pain intensity level during labor in women who consumed a pulp-free syrup composed of six dates after admission to the hospital.13
Dates are composed mainly of simple sugars (63.35 g of sugars per 100 g).3 The energy used during labor is primarily created using the oxidative pathway, so the abundance of sugar in dates helps supply the body with the 10 g of glucose needed per hour to maintain maternal energy.6 Eating dates late in pregnancy may help provide needed calories to maintain energy and prevent hunger and fatigue.6
Drawbacks
While there are many benefits to the consumption of date fruit, there are some potential drawbacks.14 Dates contain sulfites, which some are allergic to and may exacerbate wheezing in people diagnosed with asthma.14 Dates' large potassium content (656 mg per 100 g) can put an additional strain on women with kidney disease.3,14
The high sugar content can complicate diabetes or gestational diabetes.15 Dates have a low glycemic index and a medium glycemic load.15 Consuming more than one to two dates at a time could cause blood glucose levels to increase.15
Most studies on the effects of date fruit consumption on childbirth were conducted in the Middle East and had a high risk of bias.1 A trial of date fruit consumption conducted in the US would provide more information about how dates can affect childbirth in populations that do not regularly consume large amounts of date fruit. These studies also lacked a standard for the amount of date fruit and the timing of the consumption to provide maximum results.1
There is a scientific rationale behind the dates' effects, but additional studies must be completed to confirm the results.1 The studies did not include any information about the potential for date fruit consumption to induce preterm labor or premature cervical dilation. The studies were designed to have their subjects consume date fruit at 36-37 weeks of gestation, reducing the risk of preterm labor occurring before 37 weeks of gestation.
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