Gestational diabetes affects about one in five women, and it has risen globally in recent years
SINGAPORE (CNA) – Pregnancy typically marks an exhilarating phase in a woman’s journey. However, for a woman named Debby (pseudonym) at the age of 34, it evolved into a significantly stressful period due to gestational diabetes – a condition where diabetes occurs during pregnancy.
Debby, a mother of two who welcomed her children in August 2020 and April 2023 respectively, both delivered at KK Women’s and Children’s Hospital (KKH), was faced with the challenge of gestational diabetes in both instances.
Notably, the impact was more pronounced during her second pregnancy. The diagnosis arrived a little over two months into her pregnancy, compelling her to adhere to strict diet aimed at regulating her blood glucose levels.
“Even a slice of wholemeal bread would cause my blood sugar to spike. I controlled my diet very strictly and mostly ate vegetables and protein during the day but I was constantly hungry.
“Sometimes, I would wake up around midnight feeling dizzy. At that point, I wouldn’t be able to control my appetite and would sometimes eat unhealthy meals such as bread with sugar or instant noodles,” she confessed.
This cycle was only broken after the fifth or sixth month of her pregnancy when she was prescribed insulin. This kept Debby’s blood sugar under control, and she found herself able to eat healthy filling meals again.
DIABETES IN PREGNANCY AFFECTS ONE IN FIVE WOMEN
Gestational diabetes is fairly common. It affects about one in five women, noted Professor Tan Kok Hian, head of the Perinatal Audit and Epidemiology Unit at KKH.
It has risen both in Singapore and globally in recent years due to the increasing average age of childbearing, as well as an increased incidence of pre-existing diabetes and obesity in pregnancy, he said.
Why does diabetes happen during pregnancy? Associate Professor Chan Shiao-Yng, from the maternal fetal medicine division of the National University Hospital’s obstetrics and gynaecology department, explained that when a woman gets pregnant, hormonal changes take place in her body that help the foetus to grow and develop healthily.
However, these hormonal changes also make her body more resistant to insulin and cause blood glucose to rise.
Normally, the body produces more insulin to compensate for it. But in cases where the body cannot make enough insulin to keep blood glucose under control during pregnancy, gestational diabetes is likely to occur.
While it is not clear why some women get gestational diabetes and others do not, both genetic vulnerabilities and environmental factors are known to contribute to it, Assoc Prof Chan noted.
According to Prof Tan, these factors include:
- Being over the age of 35
- Being overweight before pregnancy
- Having pre-diabetes or a family history of diabetes
- Having high blood pressure
- Having a previous pregnancy which led to an unexplained miscarriage or stillbirth
- Previously giving birth to a baby who weighed over four kilogrammes (kg).
THE DANGER OF UNCONTROLLED GESTATIONAL DIABETES
Gestational diabetes increases the risk of high blood pressure in pregnant women, as well as preeclampsia (a serious blood pressure condition that occurs during pregnancy) and eclampsia (seizures that occur in pregnant women with preeclampsia).
It also increases the risk of urinary tract infection, premature delivery, gestational diabetes in future pregnancies, and the development of type 2 diabetes in the future for the mother, said Prof Tan.
Uncontrolled gestational diabetes can also be dangerous for the unborn baby. It may lead to excessive birth weight of over four kg, which may make vaginal delivery dangerous and make a caesarean section necessary.
Other complications include foetal abnormalities to developing organ systems such as the musculoskeletal and central nervous system, sudden foetal death, newborn respiratory distress syndrome (where the baby’s lungs are not fully developed and cannot provide enough oxygen), hypoglycaemia (low blood sugar in the baby), jaundice after birth, and stillbirth in rare cases, Prof Tan noted.
“In the long term, the offspring (of women with poorly managed gestational diabetes) are at an increased risk of developing obesity, diabetes and heart disease.
“This is because exposure to the less healthy environment within their mother’s womb has ‘programmed’ their tissues to be more vulnerable to challenges such as fast food and the lack of exercise they will face later in life,” Assoc Prof Chan added.
GESTATIONAL DIABETES SCREENING DURING PREGNANCY
There’s another cause for concern: “Virtually all women with gestational diabetes are entirely asymptomatic,” Assoc Prof Chan pointed out.
This is why screening for the disease is vital.
Screening is usually done via a glucose tolerance test where pregnant women are given a sweet drink, and blood samples are taken before and after the drink for testing. The test measures your body’s response to a large amount of sugar.
At KKH, this screening is routinely done between 24- and 28-weeks’ gestation, or even earlier if the expectant mother falls in the high-risk group.
In Debby’s case, because she had gestational diabetes during her first pregnancy, she was tested earlier when she got pregnant the second time – at around two to three months, she said.
LIFESTYLE CHANGES GO A LONG WAY
The majority of pregnant women are able to manage gestational diabetes through modifying their lifestyle, said Prof Tan. This includes both dietary changes and regular exercise such as a 30-minute walk after meals.
As a rule of thumb, Kellie Kong, a dietitian at KKH, recommends avoiding sugar, and sweet foods and beverages, as well as fried and oily food.
When consuming carbohydrate-containing food, she recommends choosing wholegrains, pulses (the dried seed of the legume plant, such as chickpeas), fresh fruits and non-starchy vegetables as these foods are higher in fibre and help to delay the absorption of sugar into the bloodstream, she said.
Instead of having three large meals, women with gestational diabetes should try to have small frequent meals such as three meals and three snacks throughout the day.
They should also eat the same amount of carbohydrate-containing foods or snacks at each meal for better blood sugar regulation, Kong added. For instance, if you usually eat half a bowl of brown rice for dinner, try not to double the amount or skip carbohydrates sporadically.
There is no one-size-fits-all diet. Every woman is different and their gestational diabetes diet would be individualised as well. Even if you’ve had gestational diabetes in previous pregnancies, your body may react differently.
WAYS TO MANAGE GESTATIONAL DIABETES
If you have gestational diabetes, your doctor will likely recommend that you monitor your blood sugar at home via a finger prick test with a glucometer, several times a day.
This helps you check that your blood sugar levels are within the healthy range throughout the day and allows you to figure out what foods may be causing your blood glucose to spike.
Those with more severe gestational diabetes may be prescribed metformin, an oral drug to lower blood sugar, or insulin, a hormone similar to what the body naturally produces that is effective in lowering blood sugar, explained Assoc Prof Chan. Insulin is delivered via self-administered injections.
Debby, for instance, was prescribed metformin for both her pregnancies, and also, insulin for her second pregnancy. Though initially apprehensive about insulin injections, Debby said that on hindsight, she was glad that she heeded her doctor’s
“My first baby was born with low blood sugar and was taken away from me after birth because she needed to go to the special care nursery for three to four days. I couldn’t breastfeed her, and was discharged without her. My heart ached for her and I blamed myself for not being able to control my blood sugar better.
“I was better able to control my blood sugar in my second pregnancy with insulin so my second baby was born healthy and I could breastfeed him immediately,” she said.
Though managing the condition can be challenging for many women such as Debby, Assoc Prof Chan encouraged women to persist and seek support from family and friends.
“Pregnancy only lasts for a short time so do your best to control your glucose levels for the baby and for your own sake. The hard work you put in these few months is an investment in the future.
“It could impact your future health, as well as that of your unborn child, giving your child a healthy start to life and putting your child on a low-risk health trajectory,” she said.
POST-PREGNANCY DIABETES SCREENING
The good news is, gestational diabetes typically resolves on its own within a few days to weeks after delivery. In Singapore, about 85 per cent of women have a normal glucose tolerance test six weeks after delivery, said Assoc Prof Chan.
On the flipside, that means that the remaining 15 per cent may be found to have pre-diabetes or type 2 diabetes after giving birth, and require continued lifestyle modification and treatment. Hence, follow-up screening after delivery is important.
Moreover, even those with resolved gestational diabetes have a significantly higher risk of developing diabetes later in life.
“This lifetime risk of women with resolved gestational diabetes subsequently developing diabetes can be as high as 70 per cent, with between 10 to 15 per cent of these women developing diabetes each year,” said Prof Tan.
These women should get themselves tested for diabetes at least once every three years for diabetes. Prof Tan added that annual screening might be preferred for early detection of prediabetes – earlier intervention may reduce the risk of progressing to type two diabetes.
She also recommends that mothers who have had gestational diabetes try to breastfeed for longer than six months, lose as much of their pregnancy weight as possible, maintain a normal weight, exercise regularly and maintain a healthy diet to reduce their risk of developing diabetes later in life.
