Gestational diabetes is a condition in which high blood glucose (sugar) develops during pregnancy when that person didn’t have pre-existing diabetes. It can happen at any stage of pregnancy but is more common in the second or third trimesters.
In Singapore, gestational diabetes affects almost one in four pregnancies. So, during pregnancy, target a healthy total weight gain of 11kg to 16kg over the nine months.
Risk factors for gestational diabetes
Any woman can develop gestational diabetes during pregnancy, but some may be at an increased risk if they:
* Have family members (that is, parents or siblings) with diabetes.
* Are overweight or obese before pregnancy. Before getting pregnant, women should aim to be of a healthy weight or BMI of less than 30kg/m2 as obesity increases the risk of gestational diabetes.
Gestational diabetes…is more common in the second or third trimesters. In Singapore, gestational diabetes affects almost one in four pregnancies.
While most pregnant women with gestational diabetes go on to deliver healthy babies, the condition can cause complications for the mother and child if it isn’t managed properly:
For the mother:
* Pre-eclampsia: This condition causes high blood pressure during pregnancy and can lead to pregnancy complications for both mum and baby if it isn’t treated.
* May require a C-section delivery because her baby is too big (macrosomia ― baby weighs more than 4kg at birth).
* Wound infections after delivery.
* Risk of developing Type 2 diabetes in the future.
For the baby:
* The baby grows excessively (macrosomia).
* At risk of premature birth.
* Has breathing difficulties.
* At risk of developing low blood sugar (hypoglycemia) or jaundice (yellowing of the skin and eyes) after birth, which may require hospital treatment.
Most women with gestational diabetes do not experience any symptoms. However, if the sugar levels are very high, some symptoms include being unusually thirsty all the time, frequent urination, feeling tired or nauseous (which can be similar to early pregnancy symptoms) and if sugar is detected in urine tests (conducted during each prenatal visit with the gynaecologist).
Screening for gestational diabetes
In Singapore, unless women have pre-diabetes or pre-existing diabetes, all expectant mums who are 24 to 28 weeks pregnant are advised to be screened for gestational diabetes.
If you are at high risk of undiagnosed pre-existing diabetes (such as if you have a history of gestational diabetes, have delivered a baby 4kg and heavier, or are obese), you may be screened for diabetes in the first trimester of your pregnancy. If the reading is normal, you will be checked again for gestational diabetes at 24 to 28 weeks of pregnancy.
The Oral Glucose Tolerance Test (OGTT) screens for gestational diabetes. After an overnight fast of eight to 10 hours, you will undergo a blood test in the morning to check your glucose level. You will then be given a glucose drink. Blood samples will be taken at one- and two-hour intervals to assess how your body is dealing with the glucose.
Gestational diabetes is diagnosed if your fasting blood sugar is 5.1 mmol/L or greater, your 1-hour reading is 10 mmol/L or greater, or your 2-hour reading is 8.5 mmol/L or greater.
Ways to keep gestational diabetes under control
To reduce their risk of developing gestational diabetes, Ruth Ho, a senior dietitian at NOVI Health, advises expectant women to observe the following practices before they conceive and in early pregnancy.
* Cut down your intake of sugary drinks, desserts and snacks.
* Practise portion control ― large portions of carbohydrates increase your blood glucose levels.
* Stay active and exercise regularly before and during your pregnancy. Ideally, pregnant women should get at least 150 minutes of light- to moderate-intensity physical activity every week to improve their overall fitness and reduce the risk of gestational diabetes. Safe and easy workouts include spinning and swimming.
Women with gestational diabetes will have to monitor their blood glucose levels at home using a glucometer. Some patients may require additional medication, such as oral tablets and insulin injections, for the rest of the pregnancy.
Stay active and exercise regularly before and during your pregnancy. Ideally, pregnant women should get at least 150 minutes of light- to moderate-intensity physical activity every week to improve their overall fitness.
If gestational diabetes is detected, expectant mothers can better manage their condition at Thomson Medical Centre’s Holistic Personalized (HOPE) Program for Gestational Diabetes, with the support of an experienced team of diabetes nurse educators, dietitians and medical specialists.
This programme, run in partnership with NOVI Health, consists of a full-day session and two weeks of digital health coaching through the NOVI app. The aim is to equip expectant mums with important nutrition and lifestyle management information, as well as practical skills in glucose monitoring, so as to put their pregnancy on the right path.
Those who require continued support can sign up for NOVI’s HOPE Plus Program. In this 6 month-long structured programme that follows the HOPE Program, the mothers-to-be will obtain diabetes care support for the rest of their pregnancies and into the post-partum period.
Dr Liana Koe, an obstetrician-gynaecologist at STO+G Practice, notes that most women who have gestational diabetes will return to normal after delivery. However, they do have a higher risk of developing diabetes during future pregnancies and later in life. All women with gestational diabetes are required to undergo an OGTT at least six weeks after delivery, to ensure that their blood glucose levels are back to normal. It is essential to test for diabetes or pre-diabetes every one to three years.
This story includes content from the September/October 2019 issue of Thomson Medical’s Celebrating Life magazine.
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