The Role of Date Fruit in Labor: Evidence-Based Insights for Dietitians

Date fruit (Phoenix dactylifera L.), often referred to as the “tree of life” in Middle Eastern traditions, has been consumed for centuries for its nutritional and medicinal properties. Across Middle Eastern, North African, South Asian, and Southeast Asian cultures, dates are commonly used by pregnant women in the final trimester for their potential benefits for labour.

The interest in dates has expanded globally, driven by emerging research suggesting their potential benefits for labor and delivery outcomes.

This article will explore:

• The mechanism of action of dates on labour

• What the research shows 

• Practical recommendations for dietitians and healthcare providers 

Proposed Mechanism of Action

The beneficial effects of date fruit on labor can be attributed to its biochemical composition and physiological influences:

• Prostaglandin Precursors:Dates are rich in essential fatty acids, which serve as precursors for prostaglandins. Prostaglandins are pivotal in the initiation and regulation of uterine contractions and cervical ripening. Dates may also enhance the sensitivity of uterine prostaglandin receptors, amplifying their effect and improving the efficacy of endogenous or exogenous oxytocin during labor​​

  
  

• Serotonin and Tannins:Serotonin, present in dates, supports smooth muscle contraction, including the myometrium, which facilitates effective uterine contractions. Tannins, known for their astringent properties, contribute to uterine contractions and help in controlling postpartum hemorrhage​​

  
  

• Oxytocin-like Effects:Dates are believed to contain compounds that mimic oxytocin's effects, further aiding in uterine contractions and cervical preparation

  
  

• Energy Supply and Metabolic Support:With their high carbohydrate content, dates provide a sustained energy source critical for the demanding labor process. This energy provision can support prolonged muscular activity and reduce fatigue​

  
  

• Mineral Content:Dates are abundant in calcium, an essential mineral for muscle contractions and may aid in the contraction of the myometrium, optimizing uterine efficiency​​

What Does the Research Show?

Cervical Ripening and Spontaneous Labor: One randomized control trial involving 182 nulliparous women aged 18–35 found that women who consumed 70–76 g of dates daily starting at 37 weeks, showed significant improvements in cervical ripening and a higher rate of spontaneous labor in the intervention group

Active Labor Duration: A meta-analysis of 3 trials that included three a total of 380 participants found that women who consumed dates experienced a reduction in the active phase of labor by 109 minutes on average compared to controls. Improved Bishop scores, indicative of favorable cervical conditions, were also observed in 320 participants from two trials 

Postpartum Hemorrhage: Niknami et al. (2023) conducted a trial with 98 women in Iran. The intervention group consumed 100 g of dates immediately after delivery, and their median blood loss was significantly lower (35 mL) than that of the control group (39 mL; p = 0.009)

Spontaneous Vaginal Delivery and Labor Induction: A systematic review and meta-analysis of  48 studies, including over 2,460 records, identified that the consumption of dates significantly increased the rate of spontaneous vaginal delivery and reduced the need for labor induction. For example, one included study with 200 participants reported a 21% reduction in induction rates among those consuming dates compared to the control group

Inconsistent Findings on Cesarean Rates: While some studies showed improved outcomes, others found no significant differences in cesarean rates. For instance, Bagherzadeh Karimi et al. (2020) noted no effect of date consumption on cesarean rates in their analysis of 380 participants​

No Effect on Later Labor Stages: While were found to reduce the active labor duration, studies reported no significant impact on the second and third stages of labor. For example, one trial with 180 participants found that while the active phase was shortened, the second and third stages remained unchanged

Gaps in Research

While promising, the evidence base for dates and labor has several limitations:

• Small Sample Sizes: Most studies involve fewer than 200 participants, limiting statistical power

  
  

• Diverse Dosages and Protocols: Studies vary in the type, amount, and timing of date consumption, complicating dose standardization​

  
  

• Risk of bias: While most of the studies were randomized, these types of studies cannot be double blinded 

  
  

• Generalizability: All studies have been conducted in Middle Eastern countries, and findings may not be generalizable to other populations 

Considerations for Dietitians: 

Dietitians can provide the following evidence-based guidelines regarding date consumption:

• Pregnancy Support

  • If pregnant individuals wish to consume dates to support labour outcomes, encourage them to start including dates daily at 37 weeks. The research supports a dose for 6-7 dates per day. Assess the client’s diet to determine whether this dose is appropriate

    
    

• Managing Gestational Diabetes

  • The carbohydrate content and glycemic index of dates may vary. One Mejdool dates, for example, includes 18 grams of carbohydrate of which 16 grams is sugar 

  • Including 6-7 dates per day is most likely not an appropriate strategy for individuals with gestational diabetes 

  • Advise patients with gestational diabetes who wish to include dates to:

    • Monitor blood glucose levels when consuming dates

    • Include dates as part of a meal with protein, fat and fibre 

    • Incorporate dates when they are more active e.g. before a walk 

    • Avoid consuming large quantities of dates in a single sitting to reduce the risk of rapid blood sugar spikes

    • Consult their healthcare provider before adding dates to their diet

      
      

• Respecting Cultural Traditions 

  • Respect cultural practices and individual preferences when advising on date consumption, ensuring recommendations align with clients' values and wishes.

Key Summary: The Role of Date Fruit in Labor

• Dates have been used for centuries in pregnancy, particularly in Middle Eastern, North African, and South Asian cultures

• Emerging research suggests dates can improve cervical ripening, shorten active labor, and reduce the need for labor induction.

• Proposed mechanisms:

  • Rich in prostaglandin precursors to enhance uterine contractions.

  • Contain serotonin and tannins for smooth muscle contraction and postpartum hemorrhage control.

  • Provide energy and essential minerals (e.g., calcium) for uterine efficiency.

• Research highlights find that having dates daily from 37 weeks may:

  • Support spontaneous labor and shorter active labor phases

  • Reduce postpartum hemorrhage when consumed post-delivery

  • Increase rates of vaginal delivery with fewer labor inductions

  • Gaps in research: Small sample sizes, variability in protocols, and limited generalizability to non-Middle Eastern populations

• Considerations for dietitians:

  • Tailor recommendations to individual health needs and current diet 

  • Including large portions of dates may not be appropriate for individuals living with gestational diabetes. If clients wish to include dates, close monitoring of blood sugars is recommended Date fruit is a culturally and nutritionally rich food with potential benefits for labor.

    
    
    
    

While promising, dietitians should remain mindful of the gaps in research and individualize recommendations based on each patient's health status and culture. Future research with robust methodologies will further clarify the role of dates in labor and maternal health.