Does eating dates during pregnancy improve labor?

Whether you’re pregnant for the first time or you’ve given birth before, you may be feeling anxious during the last few weeks of pregnancy when you don’t know how your labor and delivery will play out. Everyone dreams of a quick, smooth delivery, so it’s no surprise that many women are willing to try just about anything to initiate or reduce the pain and duration of labor! Eating spicy food, drinking raspberry leaf tea, walking, nipple stimulation, castor oil — you name it — the list goes on.

One practice that is quite popular is eating dates towards the end of pregnancy to improve labor outcomes (or at least, that’s the promise). In this article, I’ll review where the practice of eating dates in pregnancy for better labor originated, why it’s believed to be helpful, and (as always) the existing research on its effectiveness. 

I’ll also discuss the nutritional nuances of eating dates, including their nutrient content, impact on blood sugar, and whether there’s anything you can do to minimize the blood sugar spike from dates.

If you’re wondering if you should eat dates before your due date, this article is for you.

What are dates?

Dates are a type of fruit that grows on trees called date palms. They are commonly grown in northern Africa, the Middle East, South Asia, as well as many other parts of the world with a warm climate. There are over 600 kinds of dates and the chemical and mineral composition can differ depending on where the dates were grown.

Dates are categorized as soft (i.e. Medjool), semi-soft (i.e. Deglet Nour), and dry (i.e. Thoory). There are also several stages of ripeness of dates based on Arabic practice. These stages are: Hababouk, Kimri, Khalal, Rutab and Tamar (or Tamr). 

Dates are usually consumed at three stages of ripeness:

• Khalal (fresh, hard ripe, color stage)
• Rutab (crisp to succulent or ripe stage)
• Tamar (soft pliable, full ripe stage)

Of these three stages, Rutab or Tamar stage is when dates are ripe, soft, and sweetest. This is what you mostly find at grocery stores. While I would appreciate all of the nuance with varieties of dates, unfortunately most research on dates and pregnancy does not specify what types of dates were used. The studies that do specify, use Rutab or Tamar dates in their protocols.

Why did eating dates during pregnancy become popular?

Eating dates during pregnancy, labor and even postpartum is a common practice in some regions of the Middle East, Asia and Africa. In Islamic culture, the date is considered a sacred fruit. In Traditional Persian Medicine (TPM), dates are considered a medicinal food for labor. The Holy Quran even discusses eating dates during the Virgin Mary’s birth and its helpful effect on childbirth. Clearly, eating dates during pregnancy and labor is not a new concept.

Researchers aren’t exactly sure why eating dates may improve the experience of labor and delivery, but they have some theories. Some postulate that dates effectively ease childbirth because of how they act on the receptor for the hormone responsible for inducing childbirth, oxytocin. Date consumption is thought to induce earlier uterine contractions and improve the body’s response to oxytocin. 

Another theory is that dates may improve one’s immunity to infection by reducing the incidence of pre-labor membrane ruptures (aka water breaking). You may be thinking, but isn’t having my water break a good thing? Won’t that mean I’m in labor? While having your water break may be a natural way for labor to start, more than two thirds of women reach full cervical dilation (10 cm) before their waters break. This is actually advantageous because that membrane provides a protective cushion around the baby that prevents compression of the baby and its umbilical cord and also prevents entry of infectious bacteria. Nonetheless, water breaking before or during labor (or not at all; “en caul” births) are all a variation of normal.

Nutrients in dates

It is speculated that any perceived benefits of dates on pregnancy or labor outcomes is related to their nutritional value. As for macronutrients, dates are very high in carbohydrates, primarily from sugars (sucrose, glucose, and fructose) and a small amount of fiber, while containing very little protein or fat. As for micronutrients, dates contain low-to-moderate levels of B vitamins, vitamin C, potassium, zinc, phosphorus, iron, and magnesium. They also contain a variety of phytochemicals, such as flavonoids, lignans, and various polyphenols.

Since dates are typically consumed as a dried fruit, they are more concentrated in sugar than fresh fruit. You can see in the chart below that 100 g of dates provides 63-66 grams of sugar, which is 6 to 16.5-fold more sugar relative to an equal portion of fresh fruit (such as apples, oranges, blueberries, or cranberries). Some varieties of dates can be up to 88% sugar by weight. 

What the research says about eating dates in pregnancy and labor outcomes

Research has assessed the effects of eating dates during pregnancy (or during labor) on various pregnancy and labor outcomes, however the data is limited. For example, a 2020 meta-analysis of the existing literature on dates and pregnancy/labor outcomes included 8 studies (with data from only 6 trials) comprising fewer than 700 participants in total across all the studies combined. Most studies had participants eat between 70-100 g ( or ~4-7 dates, depending on the type) per day, although some studies used a different serving size. Here’s what we know from the existing data:

Before birth: 

• Dates and gestational duration (length of pregnancy): In a review article assessing the effects of date consumption on gestational length, it was suggested that eating ~70 g of dates in the final weeks of pregnancy significantly reduced gestational duration. However, at closer inspection of this review, several of the studies used to defend this finding did not even assess gestational duration in their study design (rather, they were looking at labor duration and/or cervical dilation). Trials performed since this review was published have not supported their conclusions. For example, one randomized controlled trial provided women with 80 g of dates (approximately 4 dates) per day starting at 38 weeks found that there was no difference between onset of spontaneous labor between the women who ate dates and women who did not. In fact, the length of pregnancy was nearly identical between the groups. Eating dates during pregnancy with the hopes of not “going over your due date” is unfortunately not founded in reliable evidence. Due dates are a giant guesstimate anyways (I prefer the terms “guess date” or “due month” instead).
  
  
• Dates and spontaneous labor: Some studies on date consumption in pregnancy show an increased likelihood of spontaneous birth, or going into labor naturally (as opposed to an induction) if dates are consumed in the last 2-4 weeks of pregnancy. For example, in one study, spontaneous labor occurred in 96% of those who consumed dates, compared with 79% of women who did not consume dates. This finding is, of course, confounded by differing practices regarding induction. For example, some practitioners want to induce at 39 weeks, whereas others wait until 41 or 42 weeks before recommending an induction.

During birth:

• Dates and cervical dilation: Cervical dilation refers to the 0-10 cm scale healthcare practitioners use to determine if the cervix is opened enough for the baby to descend into the birth canal (10 cm being “fully dilated”). A systematic review & meta analysis found that consumption of dates in the Rutab and Tamar phases at any time during pregnancy and in any amount significantly increased cervical dilation. A randomized controlled trial supported this, showing that the average cervical dilation for pregnant women at 37 weeks gestation who ate 70-75 g of dates per day (4.05±1.63 cm) was higher than the group that did not eat dates (2.97±4.63 cm). Similar findings were discovered in a prospective study that followed pregnant women at 36 weeks who consumed dates. They had significantly higher average cervical dilation upon admission compared with the non-date eaters (3.52 cm vs 2.02 cm). That said, cervical dilation does not necessarily predict labor onset or labor progression (i.e. you can be walking around at 4 cm dilated for weeks before going into labor, or you could go from 4 cm dilated to birthing your baby in less than an hour). Routinely checking cervical dilation is antiquated and not evidence-based, but unfortunately, is still quite common.

• Dates and labor duration: The jury is still out as to whether date consumption shortens the duration of labor, but there are some signs that suggest it might. Two systematic reviews and meta analyses suggest that consuming dates during pregnancy can reduce the duration of the active phase of labor; however, the quality of some of the studies included in the systematic reviews have questionable study design and a high risk of bias., Also, there has been other research showing date consumption in late pregnancy had no effect on any phase of labor.

• Dates as a labor snack: The high sugar content of dates means they can be a quick source of energy during labor. It’s estimated that you burn 50 to 100 calories per hour while they are in labor (equivalent to aerobic exercise). In fact, the smooth muscles used during labor need 20-400 times more energy than skeletal muscles that you would use on a run. However, keep in mind that the body has complex, protective metabolic systems in place to support you in times of high energy expenditure. While dates may provide immediate, quick energy, once that energy runs out, the body relies on fat storage for energy (many women are actually in ketosis during labor). Plus, depending on where you give birth, you may be discouraged from eating during labor (even though that’s not exactly rooted in strong evidence), but I digress… it is still common practice to not “allow” eating during labor in many hospital births. If you are able to have snacks in labor, dates could be helpful to have on hand.

Birthing complications:

• Dates and method of delivery: Some studies show women who consumed dates at the end of pregnancy had a lower rate of C-sections (as opposed to a physiological vaginal birth) compared to those who did not consume dates; however, not all studies have observed this correlation.

• Dates and labor pain: While I would love to tell you that dates can reduce labor pain, this has not yet been conclusively shown. Because of their pharmacological properties (effect on prostaglandins), it is speculated that consuming dates at the end of pregnancy or during labor may decrease labor pain. In one randomized controlled trial women reported less pain intensity during labor on average in the trial group that was given date syrup (dates mixed with water) than the trial group that was just given water. However, pain is subjective and is difficult to accurately measure. In animal studies, there is some research showing intake of dates provides moderate analgesic (pain relieving) properties. Dates also may have a blocking effect on pain by inhibiting the inflammatory pathway of pain sensation by suppressing prostaglandin synthesis. All of this is encouraging, but not enough to definitively say that eating dates prior to labor will reduce pain.

• Dates and postpartum hemorrhage: Postpartum hemorrhaging (PPH), although rare, is a serious condition that occurs when a woman has heavy bleeding after birth that can lead to shock or death if not treated quickly. Some data suggests that consumption of dates is associated with lower blood pressure in pregnancy, which is speculated to cause lesser bleeding after delivery. In one clinical trial, the average rate of bleeding in the first hour after delivery was much less in the trial group given 50 g of dates than in another trial group which was given 10 units of intramuscular synthetic oxytocin (Pitocin). The average amount of bleeding 3 hours after delivery between the two groups was significantly lower in the dates group. Similarly, in another clinical trial, women were either given 20 units of Pitocin or 10 units of Pitocin + 100 gram Rutab dates within 10 minutes after delivery.  After 2 hours, there was a significant difference between PPH in the two groups and the average bleeding was lower in the dates group. The researchers found that Rutab dates were more effective than Pitocin for PPH prevention.

Will dates spike blood sugar levels?

While some of the existing data shows support for eating dates and better labor outcomes, there remains a major elephant in the room: blood sugar. 

There isn’t any data that looks specifically at date consumption, blood sugar and pregnancy outcomes for both mama and baby. 

However, some of the date consumption studies have included occasional blood sugar monitoring in the study protocol. Those that do specifically exclude results from any participants who experience “any derangement in random capillary glucose reading.” For those studies, any positive findings on dates can only be applied to women with normal blood sugar levels as those who experienced high blood sugar were dropped from the study.

Let’s remember that dates are EXTREMELY high in carbohydrates (providing about 75 g of cerbohydrates per every 100 g, most of which is sugar). Approximately half of the sugar in dates is glucose, which causes a significant and rapid blood sugar spike. In the chart below, you can see that the available carbohydrate (what your body digests) and glycemic load is much higher for dates than other fruits. This particular chart only included a few types of dates, but there are many varieties of dates available, with a typical glycemic index ranging from 43 to 75. In the chart below, the glycemic index ranged from 36 to 103. For reference a glycemic index of 100 is equivalent to pure glucose.

In one study performed in non-diabetic, non-pregnant adults (13 females and 8 males), blood glucose responses were compared after the consumption of 10 dates (Deglet Noor and Khala varieties) versus a standardized 75 gram glucose tolerance test. The blood sugar responses were almost identical. That’s right, dates spiked blood sugar just as much as the dreaded glucose drink.

Should women with gestational diabetes eat dates? What if you passed your gestational diabetes screening?

If you have known blood sugar issues (currently diagnosed with gestational diabetes or are at risk for gestational diabetes), then I do not recommend eating dates. There are many risks involved with GD, to include increased risk of macrosomia, preterm labor, and preeclampsia. 

Even if you passed your gestational diabetes screening and your pregnancy has been ‘normal’ thus far, you may want to be cautious with the quantity of dates eaten in one sitting. No matter who you are, eating 4-6 dates all in one setting, will most certainly cause your blood sugar to spike. 

This type of postprandial hyperglycemia (post-meal high blood sugar) has been linked to macrosomia, neonatal hyperinsulinemia, and fetal hypoglycemia, even in infants of mothers who only had “mild gestational hyperglycemia” (meaning they do not have a formal diagnosis of gestational diabetes). In other words, babies born to mothers with mildly elevated blood sugar were more likely to grow larger than expected, have higher than normal insulin levels, and to have their blood sugar drop dangerously low after birth.

Women who have mild gestational hyperglycemia have a higher frequency of adverse maternal and fetal outcomes, to include:

• Pregnancy-induced hypertension
• Delivery complications, including shoulder dystocia
• Malformations (birth defects)
• Large for gestational age babies (macrosomia)
• Low 1-min Apgar score
• Respiratory distress
• Hyperbilirubinemia (jaundice)
• Neonatal hypoglycemia

This is because maternal hyperglycemia leads to fetal hyperinsulinism, which is involved in several of these complications, particularly hyperbilirubinemia, respiratory distress, and hypoglycemia.

Neonatal hypoglycemia is when a newborn’s blood sugar drops too low. This is most common in infants of mothers with some form of diabetes (or as above, women with mild gestational hyperglycemia). This is because elevated maternal blood sugar exposes baby to high blood sugar. Since maternal insulin does not cross the placenta, the baby’s pancreas works overtime to bring their blood sugar into the normal range via secreting more insulin. If this is a regular occurrence, the baby will continually produce high amounts of insulin (fetal hyperinsulinemia). After birth, once the cord is cut, the baby’s sugar supply suddenly halts, but their insulin production continues. This scenario of too much insulin and a sudden halt to their sugar supply results in hypoglycemia.

Of note, neonatal hypoglycemia is 1.5 times more common in non-diabetic women who gain beyond the anticipated gestational weight gain (IOM guidelines) compared to those who gain within those guidelines (more on weight gain in pregnancy here). A high-glycemic diet is highly predictive of excessive weight gain in pregnancy, even in those who pass their gestational diabetes screening tests. This again, adds more data that supports eating a diet based primarily on foods that do not contribute to large blood sugar spikes (aka a low glycemic index, real food diet as outlined in Real Food for Gestational Diabetes and Real Food for Pregnancy).

Thus, even  if you don’t have gestational diabetes, your blood sugar levels in pregnancy matter. Adverse “fetal programming” typically linked to gestational diabetes can occur to mothers who only have mildly elevated blood sugar. 

For this reason, I’m cautious about enthusiastically recommending eating LOTS of dates, even for women who “pass” their gestational diabetes screening. More nuance on this below!

But Lily, what if I combine dates with fat or protein or fiber to reduce the blood sugar spike?

This is a valid point! As I have taught for many years, eating carbohydrates alongside a source of fat, protein and/or fiber often helps to blunt the blood sugar spike (reduces the glycemic impact of the carbohydrates). I call this concept “no naked carbs” in my books, Real Food for Gestational Diabetes and Real Food for Pregnancy. 

However, this advice of “no naked carbs” does not negate the high sugar/carb content of dates. My colleague, Jessie Inchauspé of Glucose Goddess, who measures blood sugar responses to different foods while wearing a continuous glucose monitor (CGM), tested this out (image below shared with permission). She compared eating dates alone to eating dates alongside tahini and walnuts. Despite the additional fat, protein, and fiber from the nuts and tahini, the blood sugar spike was still high (>65 mg/dl). Yes, it was a slight improvement over the dates eaten alone, but you can see both experiments resulted in a steep spike followed by a crash.

During my second pregnancy, I wore a CGM several times. Out of curiosity, I tested 5 Medjool dates eaten in one sitting and on an empty stomach in the third trimester. My blood sugar spiked ~85 points and crashed rapidly. I ended up extremely hungry (hangry!), hypoglycemic, shakey, and extremely nauseous. For the sake of science, I waited a full 2 hours to get an accurate picture of what my blood sugar did before eating anything. My blood sugar response to dates was almost identical to the charts that Glucose Goddess shared. I reached max blood sugar at about 45 minutes after eating the dates, then crashed quickly.

In case you think CGMs are inaccurate, I also tested my blood sugar with a regular glucometer (finger prick) to assess the accuracy of the CGM during my “date test.” I checked my blood sugar before eating and every 15 min during the 2-hour window after eating the dates. Yes, after 9 pokes, my fingers were sick of being pricked!

My regular glucometer supported the trends from the CGM. As expected, there was a slight delay in CGM readings versus finger prick readings (this is a known phenomenon with interstitial vs. capillary glucose, as I covered in my CGM experiment article), but the overall results were very much aligned. Via my meter, I spiked and crashed about 10-15 minutes faster than the CGM readings displayed. The highest reading on the meter was nearly identical to the highest spike on CGM. My starting and ending readings on CGM and finger prick were the same.

Big spike, big crash.

In case you’re wondering, no, I did not have gestational diabetes and I have confirmed both pre and post pregnancy that my blood sugar and insulin sensitivity is quite good.

After my date experiments, I personally chose NOT to continue to consume dates during my pregnancy on a regular basis. Despite not eating dates, I had the easiest 3-hour labor ever. My midwife, who has over 30 years of experience, said it was “smooth as can be.” I don’t think eating dates would have helped anything! Our bodies know how to give birth and, in my opinion, we need to lean into that trust more than outsource our probability of success to eating random foods.

You might feel differently and want to eat dates anyways. If that’s you, keep reading.

What if I eat fewer dates in a sitting, but combined with other foods?

Now, you may think that eating 5 dates in one sitting is crazy, so what about spreading them out throughout the day? What about smaller portions of dates consumed with a source of fat or protein? These are all excellent questions. 

Recently, I wore a CGM monitor again (not pregnant) and tested out a portion of 2 Medjool dates eaten with a variety of common protein/fat combos.

In 4 separate “date experiments,” on an empty stomach, I ate a snack of 2 Medjool dates with:

• cheese
• nuts
• thick-cut bacon (sugar-free)
• nuts +  a square of 85% dark chocolate

I also tried a very popular snack bar made with the equivalent of 2 dates (dates are the first ingredient) that combines it with egg white protein, almonds, and cashews. This bar provides 24 grams of carbohydrate and 12 grams of protein.

For all of the combinations, including the popular snack bar, my blood sugar spiked significantly (average rise in blood sugar was >40 mg/dl, the highest being +51 mg/dl). This is more than my blood sugar rises for a typical meal for me! All the graphs looked very similar to this one below.

Finally, I tried eating dates alone or in combo with a protein/fat option after a high-protein, low-carbohydrate meal.

The only time my blood sugar did not spike excessively was when I consumed dates after a high-protein, low-carbohydrate meal.

In the first test, I tried 2 dates eaten after a meal of curried chicken salad over greens. In the second test, I tried 2 dates plus cheese eaten after a meal of eggs, a slice of bacon, and ½ piece of buttered homemade sourdough toast. Both of these meals provided 25-30 g of protein and <15 g of carbohydrate). 

Even after accounting for the dates, my blood sugar only rose 10-15 points and slowly returned to baseline. In other words, there was no spike and no crash.

Why would dates eaten after a high protein meal prevent a big blood sugar spike?

The order in which you eat foods can lessen the blood sugar spike. The fiber from vegetables slows the absorption of glucose from your digestive tract and the protein and fat in meat/eggs helps stabilize your blood sugar and prevent a crash afterwards. 

Plus, protein is known to induce a small insulin response, but not to elevate blood sugar. This means that by the time you’re eating dates, there is already insulin circulating to help shuttle blood sugar out of your bloodstream before it rises too high. 

Lastly, by eating an overall lower carb meal, you can avoid an “additive effect” of too high of a carbohydrate load from that meal (less risk of a big blood sugar spike). In other words, you’re treating dates like your dessert.

This effect probably would not work well after a high carbohydrate meal, such as one that includes pasta, oatmeal, or rice. In that scenario, you’d simply be adding “fuel to the fire” of a preexisting blood sugar spike.

If you really enjoy eating dates and you do not have gestational diabetes, you might still choose to eat dates. If that’s you, here are some options to help lessen the blood sugar spike:

• Consider having no more than two dates in a sitting to minimize the blood sugar spike.
• Consider having a meal or snack of meat, chicken, fish or eggs alongside a green vegetable side prior to having dates. Think of dates like dessert! Bonus points if you combine dates with a source of protein, fat, or fiber to further blunt the blood sugar spike.
• Consider the carbohydrate load of the rest of your diet. If you choose to eat 4-7 dates per day, that can add an additional 60-105 grams of carbohydrates (it depends on the type & size of the dates). You may choose to have the dates replace other carbohydrates, particularly other quickly digesting or low nutrient density carbohydrates, such as added sugar, pasta, white bread, or white rice.
• Try going for a 10-20 minute walk after having dates. Your muscles will use the extra glucose in your bloodstream for energy, resulting in a smaller blood sugar spike. (That said, in one of my date experiments, I did go for a 20 minute walk after having dates and my blood sugar still rose >40 mg/dl. Dates after a high-protein meal was far more effective at preventing a spike than exercise after eating dates.)

If you try the above, consider using a blood sugar meter to check your readings every 15 minutes for 2 hours after eating dates to confirm that you do not spike and crash too violently. At minimum, check at 45-60 minutes after eating and again at 2 hours. (Alternatively, try a CGM, which will give you minute-by-minute readings). 

In the U.S., you’ll need a prescription to obtain a CGM, but you can get a normal glucometer over the counter at any pharmacy. If you’re not currently pregnant, a service like Levels is also an option (at the time of writing, they do not provide CGMs if you are pregnant). If you are pregnant and in the U.S., you’ll need to work with your provider directly to obtain a CGM.

Also pay attention to how you feel after eating dates. If you’re not checking your blood sugar directly, your symptoms can relay clues of blood sugar imbalances.

• Do you get jittery (as if you’ve had lots of coffee on an empty stomach)?
• Does your pulse and/or heart rate increase (as if your heart is beating out of your chest)?
• How soon after eating dates are you hungry? Is your hunger insatiable?
• How are your energy levels? Were they sustained or did they rise, then tank?
• Did you get sleepy or foggy headed and feel like taking a nap?
• Did you get digestive discomfort or nausea?

Any of the above can be indications of a blood sugar spike and crash, which is a very stressful situation metabolically for your body. If that’s you, you might choose to forgo the dates altogether. Every body is different. Just because I could avoid a spike by eating them after a high-protein meal doesn’t mean that will be the case for you.  

So what is the final verdict on eating dates during pregnancy?

Are dates the miraculous antidote for improved labor outcomes that we’d like them to be? At best, we can say, “maybe,” but probably not to any extreme. We know that:

• Eating dates during pregnancy, labor and even postpartum is a common practice in some parts of the world. In Islamic culture, the date is considered a sacred fruit. 
• Dates are very high in carbohydrates with just 100 grams (around 4-6 dates) providing about 75 grams of carbohydrates, more than 63 grams of which is sugar. 
• Before birth, there are some studies that suggest date consumption may decrease gestational duration and increase the likelihood of natural labor, though not all studies are in agreement.
• During birth, it’s been found that date consumption in pregnancy may increase the rate of cervical dilation. However, the jury is still out if date consumption reliably shortens labor. Dates can make for a great labor snack if you need a boost of energy.
• There is inconclusive evidence that eating dates will decrease the likelihood of C-sections and reduce labor pain. However, eating dates may reduce the amount of bleeding after delivery. 
• There have not been studies to assess the glycemic impact of eating dates during pregnancy, however studies performed outside of pregnancy, show that dates can induce an equivalent blood sugar spike to a glucose tolerance test.
• Even slightly elevated blood sugars have been linked to high insulin levels in infants at birth and other adverse outcomes (especially neonatal hypoglycemia), so if you choose to consume dates, do so in a way that minimizes the risk of high blood sugar. Fetal insulin levels are a direct reflection of maternal blood sugar levels.
• To minimize the blood sugar spike from eating dates, consume them after a high-protein, low-carbohydrate meal. This is far more effective at avoiding a blood sugar spike than eating dates as a snack, even when that snack includes a source of fat, protein, or fiber.

All in all, whether you eat dates or not during pregnancy, I hope you have a better understanding of why dates are a popular topic and how you can make eating dates work for you, if you so choose. 

Lily

PS — Did you eat dates during pregnancy? How were your labor outcomes? Tell me in the comments below. Also, if you’ve ever done your own “date experiment,” I’d love to hear what you learned from blood sugar monitoring. Did they spike you the same as me? More? Less? 

 

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