Diabetes is a condition where the glucose (sugar) level in the blood is too high. Gestational diabetes (GDM) is a category of diabetes that affects women during pregnancy. In most cases, GDM develops in the middle or towards the end of pregnancy, and resolves after giving birth. It is very common and affects about one in five pregnant women in Singapore.
Should I be screened for Gestational Diabetes?
Screening is recommended and is usually done at 24 to 28 weeks of pregnancy. Earlier testing can be done for women who are deemed to be at a higher risk:
Body Mass Index (BMI) > 25kg/m2
Previous baby > 4kg at birth
Have a history of Gestational Diabetes
Known prediabetics
Have a family history of diabetes
40 years old and above
How will I be tested?
Gestational Diabetes is detected by using an oral glucose tolerance test (OGTT). It involves fasting from midnight the night before the test. When you arrive at the clinic, a fasting blood test will be conducted. You will then be asked to consume a glucose drink within 5 minutes and have your blood taken at one and two hour intervals.
What are the impact on pragnancy and the baby?
Most women with GDM have healthy pregnancies and healthy babies when their blood glucose level are well controlled during pregnancy. This also reduces the risks of complications.
However, certain complications can occur if your blood glucose is too high:
Your baby growing bigger than average. A big baby increases the chance of injury during delivery as the baby’s shoulder may be stuck in the pelvis.
Your baby has a higher chance of a low blood sugar level or jaundice after birth.
Your baby may have low sugar levels after birth and require additional care in the neonatal unit.
You may be at a higher risk of developing diabetes later in life.
You having a higher chance of developing high blood pressure during pregnancy, preterm birth, needing induced labour or caesarean section, and stillbirth (death of baby in the womb).
Management and Treatments for Gestational Diabetes
In most situations, having a healthy eating and exercise plan will be enough to control your GDM. It is important to have well balanced meals to support your pregnancy. A dietitian will work with you on an individualised healthy eating plan. You will also be advised on controlling meal portion sizes and eating at regulartimes to promote better blood glucose control.
It is also recommended that you keep active with regular exercise (such as walking) during pregnancy. You may wish to discuss this further with your doctor.
If your blood glucose levels are not controlled even with diet and exercise, or if an ultrasound scan shows that your baby is larger than expected, you may need medication. It is usually given as injectable insulin. This will be explained at your next appointment with your obstetrician and/or endocrinologist.
How do I monitor my blood sugar level?
You will be taught how to monitor your blood glucose at home and what the ideal glucose level should be.
The nurse will show you how to do a finger prick test. You will be given a chart to note down your readings. Do monitor your blood glucose levels at least two days a week, seven times a day (before and two hours after each main meal and before bedtime). You will be informed if you need more frequent monitoring.
How will my blood glucose be controlled during delivery?
The team will closely monitor your blood glucose level during labour. If required, intravenous insulin infusion will be given to you during your labour.
Postpartum care
As your baby is at risk of having low blood glucose after birth, his or her blood glucose will be tested. If his or her blood glucose is low, it will be treated until it is in the normal range.
You will be advised to repeat the OGTT 6 to 12 weeks after delivery. It is important that you have this test as a small number of women continue to have abnormal glucose tolerance after pregnancy.
Women who have GDM are more likely to develop diabetes later in life. You can reduce this risk by adopting a healthy lifestyle including healthy diet, exercise and weight loss (if you are overweight). You should also be screened for diabetes once every one to three years.
Lastly, you should let your doctor know about your condition when planning for future pregnancies as GDM may recur
Resources and Support
You may also refer to our brochure here for details.
