The International Diabetes Federation estimates that one in seven births are affected bygestational diabetes mellitus (GDM) worldwide. Studies conducted locally have shown that Asians have a higher risk of the condition, and a 2012 multinational study found that the Republic has one of the highest rates of GDM in the world.

“GDM is a condition that affects about one in five pregnant women in Singapore. It occurs because the body does not produce enough insulin, a hormone which controls blood sugar level. During pregnancy, the placenta produces a number of hormones, some of which may impair the production and function of insulin,” said Dr Tan Toh Lick, resident obstetrician and gynaecologist at Thomson Medical Group.

“When a pregnant woman has GDM, her pancreas produces more insulin to cope with the high level blood sugar or glucose. The insulin does not cross the placenta but the glucosedoes, giving the baby high blood glucose levels. The extra energy from the glucose becomes fat, sometimes resulting in a big baby. The baby’s pancreas will produce insulin to counter this and this excess insulin will raise the baby’s risk of being obese or diabeticin future,” explained Tan.

Mothers with GDM could potentially develop high blood pressure, enter pre-term labour, have difficult deliveries such as shoulder dystocia, or have an increased risk of stillbirth. The baby could be affected as well and risk having breathing difficulties, low blood sugar, and jaundice. Mothers with GDM also face a higher risk of developing diabetes in the future.

Symptoms and diagnosis

Typically, women with GDM display no symptoms. However, in some cases, the following symptoms may be present such as increased thirst, increased urination, increased appetite, increased fatigue, or recurrent infections noted Tan. Therefore, your obstetrician or family doctor will screen for GDM and offer testing typically between 26 and 28 weeks of pregnancy in the form of an oral glucose tolerance test.

Screening and prevention

Testing for GDM will be recommended to all pregnant women at the 24th to 28th weeks of pregnancy in Singapore, not just those with high-risk factors. This announcement was made at the recent Singapore Diabetes in Pregnancy Conference by the College of Obstetricians and Gynaecologists Singapore (COGS) at KK Women’s and Children’s Hospital (KKH). Previously, only pregnant women identified with high-risk factors – including high body mass index, previous large baby, a family history of diabetes or coming from ethnic background with high prevalence of diabetes – were highlighted for GDM testing.

“All pregnant women should be screened for their risk of GDM during their pregnancy to tailor GDM testing. If a woman has GDM in her previous pregnancy, she should start self-monitoring of her blood glucose when she is pregnant again, and/or offered testing shortly after booking her pregnancy. If this is normal, she should be offered furthertesting between 26 and 28 weeks of pregnancy as with all other pregnant women,” said Tan. As it is more common in overweight women, it is a good idea to lose any excess weight prior to pregnancy.

“During pregnancy, work with your family doctor or obstetrician to keep your weight gain in check. Make an effort in eating a varied and nutritious diet, in sensible portions. Homecooked food is great to enjoy, as it provides more control over your salt, sugar, and fat intake. Also get into the habit of doing something active every day that is safe for pregnancy such as yoga, pilates, walking, and swimming,” advised Tan. MIMS

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