According to the International Diabetes Federation, the prevalence of gestational diabetes mellitus (GDM) in women worldwide is about 1%. GDM is usually defined as diabetes that develops or is first diagnosed during pregnancy. However, it can also be defined as “insulin resistance” or “carbohydrate intolerance” during pregnancy.

Studies have also shown that Asian women are at greater risk of developing GDM during their pregnancies, and that such a condition increases the health risks for mothers and their babies. GDM continues to remain one of the most common morbidities of pregnancy, and its prevalence is expected to increase as obesity rates rise.

“A pregnant patient who is at high-risk for GDM is identified as having a high body mass index, has a family history of diabetes, a personal history of previous GDM or large babies of more than four kilogrammes, previous poor obstetric outcomes usually associated with diabetes, is 35 years old and above and have experienced two episodes of consecutive glycosuria (sugar in urine),” explained Ms Bibi.

Based on Singapore’s largest and most comprehensive birth cohort study, Gusto, one in five of 1,136 pregnant women in Singapore tested had GDM, more than double of the 9.2% rate found in the United States. This was despite half of the Singaporean women assuming low risk, thus not usually including such a test as part of a regular check-up routine.

Managing high blood sugar during pregnancy

GDM develops in women during pregnancy because the mother’s body is not able to produce enough insulin. Insulin is a hormone that enables the body to break down sugar (glucose) to be used as energy.

Without sufficient insulin, the amount of sugar in the blood rises. High blood sugar levels in the mother’s body are passed through the placenta to the developing baby.

Ms Bibi highlighted that there are significant risks to a baby exposed to high blood sugar during development, including various birth defects and shoulder dystocia whereby shoulders of large babies can dislocate or become stuck during vaginal delivery.

“This could potentially lead to a broken clavicle or neurological damage to the infant, a medical emergency for the mother, or hypoglycaemia, jaundice and permanent changes to a child’s metabolism. Additionally, patients may face increased risks of preterm birth, induced labour, caesarean sections, serious birth problems and stillbirths,” she added.

GDM is also believed to be an early indicator for the later development of diabetes, which means a woman’s insulin resistance would continue or worsen for years after they give birth. Women who have GDM have a much higher risk of developing Type 2 diabetes later in life.

“GDM usually begins in the second half of pregnancy, and goes away after the baby is born,” she said. “This makes it different to the more common forms of diabetes which, once they occur, are permanent.”

This condition can be detected by using an oral glucose tolerance test (OGTT) and is usually done during the 24th to 28th week of pregnancy. Earlier testing can be done for women who are deemed to be at higher risk.

Healthy diet and regular exercise remain crucial

In most situations, having a healthy eating and exercise plan will be sufficient to control one’s condition.

“It is important to have well-balanced meals to support one’s pregnancy. The patient has to adjust her diet and exercise levels accordingly and remind their doctors to check their blood sugar every one to three years,” said Ms Bibi.

She also noted that carbohydrates tend to raise blood sugar the most, fat and protein tend to stabilise blood sugar, and exercise tends to lower blood sugar.

“As such, patients should reduce their sugar intake, snack on fruits and consume foods with plenty of fat and protein. Choosing foods with a low GI helps them manage their condition better as these foods take longer for their bodies to digest and glucose is released more slowly into the bloodstream. Some examples of such foods include pasta made with durum wheat flour, apples, oranges, pears, peaches, beans and lentils, sweetcorn and porridge,” she advised.

She also advised patients to keep active with regular exercise (such as walking) during pregnancy, as exercising regularly for about 30 minutes a day is particularly helpful in reducing blood sugar levels.

Fast walking, swimming, cycling, or even going up and down the stairs are all good ways of increasing one’s heart rate. The key, she stressed, was to avoid being still for long periods of time, such as sitting at a desk or watching TV for hours on end.

“Patients whose blood glucose levels are not controlled even with diet and exercise may need medication, and this is usually given as injectable insulin,” she concluded. MIMS

Read more:
Gestational diabetes may increase likelihood of attention problems in babies
Targeting the needs: Gestational Diabetes Mellitus (GDM) screening included in KKH prenatal care
Malaysia ranks fourth amongst Asian countries for highest number of diabetics