Mariam Sattar has fasted for the 30 days of Ramadan every year since she was 7. It is a special time, a time when she feels closer not only to God, but to the millions of fellow believers around the world as they celebrate the most important holiday of their faith.

This year, however, the 22-year-old is four months pregnant. And despite the counsel of her gynecologist and the worries of her husband, the bubbly University of Houston biochemistry graduate wants to fast for as many days as she can during Ramadan, which begins Friday.

"There's this extra spiritual upliftment," Sattar said. "Any other day if you tell me to fast when I'm pregnant, I'm going to say, 'Oh my gosh, no thank you, I can't do that.' But when Ramadan comes by it's like, 'Of course, why wouldn't I?'"

Sattar is far from an outlier. Though most Muslim scholars agree that Islam exempts pregnant and breast-feeding women from fasting during Ramadan - which prohibits eating and drinking from sunrise to sunset - many still do.

Sattar's gynecologist. Dr. Dipika Ambani, said she sees about three pregnant Muslims a day in her Houston practice and most choose to fast, though she urges them not to. On a recent day this week, for instance, she counseled five.

"Two of them said they were going to fast no matter what," Ambani said. "Three of them asked my opinion, and when I told them it wasn't a good idea, they were kind of sad. I didn't know from their faces whether they were going to do it or not."

Likewise, Ambani told Sattar it's unwise. The young mother listened, then went home and did her own research online, decided she could re-hydrate sufficiently and boost her calories after dusk and before dawn, and was ready to take the plunge.

"You become this whole different person during Ramadan," she explained.

Five pillars of Islam

Sattar embodies, perhaps, the conflict some American Muslims feel during this annual period of reflection and worship. They lead modern lives and are highly educated and financially well off, but also deeply serious about their faith.

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Ramadan fasting poses quandary for mothers-to-be