Gestational diabetes cases are soaring, and you (as well as your baby)
might be at risk witout even knowing it.

WORDS CINDY LIM

hen Foo Siew Min, 35, a business development director, was into the last trimester of ther pregnancy, she suddenly developed an unquenchable thirst after each meal. She would drink about ten glasses of water throughout the day to soothe her parched throat. Puzzled, she consulted her obstetrician who diagnosed her as having gestational diabetes after doing some tests.

“I could not believe what I was hearing from the doctor! Different worse-case scenarios were racing though my head and I was trying to recall if any family of friends went through this before. I kept wondering about this condition and worrying how my baby was going to be affected!” recounts Siew Min of the initial shock she went through.

What is Gestational Diabetes? Gestational diabetes mellitus (GDM) Is a type of diabetes that occurs only during pregnancy. Like other forms of diabetes, gestational diabetes affects the way your body uses sugar (glucose). Around four to five percent of pregnant Women will have GDM.

“Some degree of impaired glucose Intolerance will occur in all pregnant women as a result of hormonal changes that occur during pregnancy leading to higher blood sugar levels. During the later part of pregnancy (the third trimester), these hormonal changes place pregnant woman at risk for gestational diabetes.

Usually the mother’s pancreas is able to produce more insulin to overcome the effect of the pregnancy hormones on blood sugar levels. If, however, the pancreas cannot produce enough

insulin
during pregnancy, blood
sugar levels will rise, resulting
in gestational diabetes,”
explains Dr Kelly Loi,
obstetrician & gynaecologist, Health &
Fertility Centre for Women.


Do I have Gestational Diabetes?
Some common symptoms of diabetes Include frequent thirst, recurrent vaginal Infections and in some cases, glycouria (detection of sugar in the urine). However, in pregnancy, GDM is often asymptomatic and doctors do not rely on symptoms to diagnose GDM.

According to Dr Chee Jing Jye, medical director, The Obstetrics & Gynaecology Centre, a subsidiary of the Singapore Medical Group, the only way to diagnose GDM is through a special blood test called oral glucose tolerance test (OGTT).

“At every antenatal visit, the pregnant woman’s urine would be tested for glucose. If the urine glucose is very high, the GDM is suspected, and the woman will be advised to undergo OGTT at 28 weeks. Otherwise, all Pregnant women at risk of developing GDM would be advised to undergo OGTT at 28 weeks of pregnancy, even if

their urine glucose is not high,“ explains Dr Chee.

How will I be Affected by
Gestational Diabetes?
Typically, many women who develop GDM have no know risk factors. However, in some cases, GDM can increase the expectant mother’s Personal risk of :

Pre-eclampsia. Gestational diabetes increases the risk of pre-eclampsia, a condition characterized by high blood pressue and excess protein in the urine after 24 weeks of pregnancy. Left untreated, pre-eclampsia can lead to serious or even life-threatening complications for both mother and baby.

Urinary tract infections. Women with gestational diabetes experience twice the number of urinary tract infections during pregnancy than other pregnant women experience. This is likely due

to excess glucose in the urine. If the infections become severe, premature delivery may occur.

Future diabetes. If you have gestational diabetes, you’re more likely to have it again with a future pregnancy. You’re also more likely to develop diabetes, as you get older.

How will my Baby be Affected?
The babies of mothers with GDM may be at an increased risk of:

Excess growth. Extra glucose can Cause your baby to grow to big while Developing in you womb (macrosomia). Very large babies are more likely to get wedged in the birth canal. This may result in the babies sustaining birth injuries or requiring assisted delivery (like forceps and vacuum) or Caesarean Delivery.

Excessive amniotic fluid. There may be formation of excessive amniotic fluid around the unborn child if the gestational diabetes is not well-controlled. This large volume of fluid inside the womb predisposes premature rupture of membranes and the associated risks of infection and premature delivery.

Low blood sugar (hypoglycemia). Sometimes babies of others with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth. If the baby’s blood sugar is too low, The baby may have fits. Rarely brain Damage may result. Close monitoring

of babay’s blood glucose levels, regular mik feedings and sometimes an intravenous glucose solution is necessary to ensure the well-being of the baby.

Respiratory distress syndrome. Babies born to women with gestational diabetes tend to have more breathing problems than those born to women without the problem even at term. Babies who have respiratory distress

Who is at Risk
of Developing
Gestational Diabetes?

Risk factors for developing gestational diabetes include:
  • Age 35 or older.
  • Overweight. If your pre-pregnancy body mass index (BMI) is 28 or higher.
  • Family history of diabetes. If a close family member, such as a parent or sibling, has diabetes, your risk of developing gestational diabetes is higher.
  • Personal history of gestational diabetes. If you had gestational diabetes in previous pregnancies, the chance of having it again in subsequent pregnancies is higher too.
  • Past history of delivering babies who weighed more than 4kg.
  • Past history of unexplained stillbirth.
Women with risk factor(s) for developing gestational diabetes should be tested with OGTT at 28 weeks of pregnancy.

syndrome might need to stay in Neonatal Intensive Care Unit to receive help with their breathing until their lungs become stronger.

Jaundice. The incidence of jaundice is higher in babies of women with gestational diabetes. Although jaundice can usually be treated with phototheraphy; permanent brain damage may result in severe cases.

Diabetes later in life. Babies of mother who have gestational diabetes have a higher risk of developing obesity and diabetes later in life.

Rarely, untreated gestational diabetes results in a baby’s death either before or shortly after birth.

Treatment for
Gestational Diabetes

When diagnosed with GDM, close

monitoring of the mother’s blood sugar levels as well as growth of the foetus is needed.

“If you are diagnosed with gestational diabetes you should try to keep you blood sugar levels within normal range at all times. You will be taught to monitor your blood sugar leve (home glucose monitoring) using a glucometer. You will need to know how to modify you diet such that it will provide sufficient nourishment for you and your baby while maintaining a control on the blood glucose levels,” explains Dr Chee.

“Dietary control will be used as first line of management 90% of women with gestational diabetes can be managed with dietary control alone. For the remaining 10% of patients whose blood sugar cannot be controlled with diet alone, they will need treatment with insulin.”

Will Gestational
Diabetes Go Away?

Most women with GDM do not remain diabetic after the baby is born. Once you have had GDM however there is a higher risk of developing it again during a future pregnancy.

“GDM typically resolves after birth. I would usually advice a repeat OGTT postnatal at six weeks after delivery to ensure that sugar levels have returned to normal. However, women who have GDM are at a higher risk of developing Type II diabetes in later life and should endeavour to always maintain a healthy diet and lifestyle,” shares Dr Loi.

Though gestational diabetes has been linked to several health concerns for your baby, there is plenty you can do to mitigate this risk. Make healthy choices about your diet and lifestyle and this will enable a healthy pregnancy and help prevent diabetes in the future.

“I seldom exercise and I have a sweet tooth, so perhaps that contributed to why I developed gestational diabetes,” shares Siew Min.

“I had to make changes to my diet - strictly wheat/ wholemeal instead of white bread, reduce and eliminate white rice and switch to brown rice, and to have a less sedentary lifestyle. This helped to regulate my blood sugar level and I managed to have a smooth delivery and healthy baby. I may still be at some risk of developing diabetes later in life, so I constantly remind myself to eat better and exercise more.”

Another mum who changed her diet and lifestyle is Ivy Ong, 32, a stay at home mum to Athena, 2, and Aloysius Teo, 8 months. She was diagnosed with

GDM during her second pregnancy.

“To control my blood sugar level, my doctor recommended that I switch my diet to brown rice, wholemeal breads and a slice of fruit at every meal. No snacking was allowed and I was advised to drink only warm water. I was not used to such a strict diet and lifestyle at first, but for the sake of having a healthy baby and to reduce my rise of developing diabetes later in life, I was determined to follow through.

All that diet control was worth it. I had a smooth pregnancy and delivery and my son is very healthy. Try and endure for the fw months during pregnancy and you and your baby can be diabetes-free for the rest of your life,” advises Ivy.