Pregnancy can open you up to different conditions you thought your otherwise healthy body would never have. For instance, a lot of Singapore mums reported having gestational diabetes, a form of diabetes that appears only during pregnancy. Are you wondering if you are at risk for this condition? Read and find out.
Gestational Diabetes in Singapore: Mum Shares Her Story
Mummy Tan Poh Hong was diagnosed with gestational diabetes when she was 28 weeks pregnant. She gave birth to her little one in April 2019. Here, she tells us more about the condition and how it affected her.
“I was diagnosed with gestational diabetes at 28 weeks – prior to that there were no symptoms. This is my second pregnancy and my baby was delivered in April 2019,” says Mdm Tan, who is also mummy to a 9-year-old.
“The diagnosis was done through glucose tolerance test. My mum has diabetes too (which was discovered at age 52). After the diagnosis, I was referred to a diabetes specialist. Initially, I was given a tracking device to scan for my sugar levels every day for 2 weeks.”
The expecting mum was also advised to watch her diet by cutting down on carbohydrates and was asked to avoid sugary food or drinks.
“I felt giddy initially when I adjusted my diet. But after the second check-up, when the sugar levels seemed to be under control, I didn’t have to track them strictly anymore as my doctor felt that I was independent enough to watch my diet well. My appointment was adjusted to a monthly visit,” she shared.
“As to whether the gestational diabetes affected my health, I did experience some weight loss,” she added.
Mdm Tan, however, did not have to take insulin or medication, only diet control was required. Her baby’s weight at birth was 2.5kg. The baby was not abnormally big and was delivered by elective C-section. Her doctor advised her to continue to watch her diet and sugar intake.
“Gestational diabetes can actually happen to anyone,” she said. “However, being watchful of your diet and exercising regularly can help in the overall well-being of mummy and baby.”
What Is Gestational Diabetes: Expert Opinion
Gestational diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. Too much glucose in your blood is not good for you or your baby.
“The real reason for gestational diabetes (GD) is not known,” said Dr Christopher Chong, Obstetrician, Gynaecologist and Urogynaecologist, Gleneagles Hospital,
“The term gestational means during pregnancy and most patients are not diabetic to start with and even if they have GD, this reverts to normal naturally in 6 – 8 weeks post-delivery.”
“The common postulate is that the body, for that patient, could not handle the sugar load as well as before pregnancy due to the fact that the placenta produces hormones during pregnancy and these hormones counteract or reduce the action of insulin,” he explained.
“In the 3rd trimester, there is a higher rise of these placenta hormones and typically, GD is assessed or discovered in the 3rd trimester. This phenomenon is different for different individuals and most patients will not have GD,” added Dr Chong.
Signs and Symptoms of Gestational Diabetes
According to the doctor, there are no known symptoms of gestational diabetes. Symptoms such as increased thirst and frequency of urination are very non-specific. However,
“Signs to suggest a need to check for GD include excessive weight gain in pregnancy, excessive water ( called liquor ) in the water bag, a big foetus on ultrasound scan and recurrent sugar-positive on routine urine dipstick test which is usually done on every antenatal visit,” he said.
Am I at Risk of Getting Gestational Diabetes?
A woman’s risk for developing GDM increases if she:
- Is over the age of 35 when she became pregnant
- Is overweight before she became pregnant
- Has pre-diabetes before she became pregnant
- Has a family history of diabetes
- Has high blood pressure
- Had a previous pregnancy which led to an unexplained miscarriage or stillbirth; or the birth of a baby who weighed over four kilos
- Have pre-diabetes, meaning your blood glucose levels are higher than normal yet not high enough for a diagnosis of diabetes
Effects of Gestational Diabetes
What Gestational Diabetes Does to You
When a pregnant woman has gestational diabetes, her blood sugar crosses over to high levels. Hence, her body produces more insulin to cope with this high level of blood sugar or glucose. The insulin does not cross the placenta, but the glucose does, giving the baby high blood glucose levels.
The extra energy from the glucose becomes fat, sometimes resulting in a big baby. A big baby could mean complications for a mother during childbirth. The baby’s pancreas will produce more insulin to counter this high level of glucose, and excess insulin will put the baby at risk of being obese or diabetic in future.
Here are the risks of gestational diabetes for the baby:
- Excessive weight at birth > four kilos (macrosomia)
- Fetal abnormalities
- Sudden fetal death
- Fetal respiratory distress syndrome
- Low blood sugar or hypoglycaemia after birth
- Jaundice after birth
- Type 2 diabetes later in life
How Does Gestational Diabetes Affect Me?
Gestational diabetes may increase your chances of:
- having high blood pressure and too much protein in the urine
- having surgery—called a cesarean section or c-section—to deliver your baby because your baby may be large
- becoming depressed
- According to a local study, around 10 per cent of women who suffer from gestational diabetes develop type 2 diabetes within five years, compared with 1% of women without the condition.
Dr Chong adds,
“Often GD is not severe and often asymptomatic. If not controlled well, the patient may develop high blood pressure in pregnancy and it may affect the growth of the foetus. Long-term risks include the increased risk of GD in subsequent pregnancies and that of diabetes mellitus later in life.”
Image Source: Shutterstock
How Is Gestational Diabetes Diagnosed?
You will probably be tested for gestational diabetes between weeks 24 and 28 of your pregnancy. The most accurate blood test is the Oral Glucose Tolerance Test.
You will need to fast for at least 8 hours before the test. Your fasting blood glucose level will be checked before the test begins. Then you will drink a sugary beverage. Your blood glucose levels will be checked 1 hour, 2 hours, and possibly 3 hours later. Your doctor will use your test results to find out whether you have gestational diabetes
Is there a cure for gestational diabetes?
The cure for gestational diabetes involves keeping your blood sugar levels under control. You can do this by:
- Healthy eating – Your doctor or dietitian will help you with your dietary plan. The plan will help you know which foods to eat, how much to eat, and when to eat. Try not to skip breakfast and avoid sugary drinks and snacks.
- Physical activity – Be as physically active as you can. Aim for at least 30 minutes most days of the week. However, do check in with your doctor on what sports or exercises are safe for you during pregnancy.
- Insulin shots, if needed – Again, your doctor will be the best person to advise you on whether you would require insulin shots. Note, insulin will not harm the baby.
How to Prevent Gestational Diabetes
Can I lower my chances of getting gestational diabetes?
This is what Dr Chong has to say:
“Gestational diabetes is not easy to prevent as the anti-insulin extent from the placenta cannot be measured or predicted.”
Preventive measures include being healthy before pregnancy, losing excess weight before conceiving (obesity is linked to increased risk of GD ), exercising, eating healthy food and maintaining an ideal weight range.
Diet for Women with Gestational Diabetes
According to Kellie Kong, a Dietitian with the Department of Nutrition and Dietetics in KK Women’s and Children’s Hospital (KKH), the important points to consider for women with gestational diabetes include the types of carbohydrate-containing foods, the quantities and the timings in which these foods are consumed.
“It is important to note that diet for pregnant women with gestational diabetes is individualised based on several other considerations, such as pre-pregnancy weight status and rate of weight gain during pregnancy, blood glucose level control as well as individual’s lifestyle and medical management,” she added.
What can an expectant mum with gestational diabetes eat? Here are some tips straight from the expert:
- Choose whole grains, pulses, fresh fruits and non-starchy vegetables as these foods are higher in fibre, which helps to delay the absorption of glucose into the bloodstream, thereby helping to control blood glucose levels.
- Choose skimmed or low fat plain milk and yoghurt, hi-calcium unsweetened or reduced sugar soy milk for adequate calcium intake.
- Avoid sugars, sweet foods and beverages, as these are usually low in nutrients and high in energy value, which can increase your weight gain too quickly. Artificial sweeteners may be consumed in moderation.
- Avoid fried and oily foods as these are digested slowly, thus keeping blood glucose levels high for a prolonged duration. High fat foods can also contribute to excessive weight gain.
- Regular distribution of carbohydrate-containing foods throughout the day helps to optimise blood glucose levels. Instead of three large meals a day, it is recommended to try having small, frequent meals throughout the day, i.e. three meals and three snacks.
- Having regular meal timings every day is also important. In addition, eating the same amount of carbohydrate-containing foods daily at each meal and snack helps to regulate blood glucose levels.
Image source: iStock
Updates by Camille Eusebio
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