What is gestational diabetes and how does it affect pregnancy?

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 nine-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 two 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 or gestational diabetes mellitus (GDM) 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 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 six to eight weeks post-delivery," said Dr Christopher Chong, Obstetrician, Gynaecologist and Urogynaecologist, Gleneagles Hospital.

What causes gestational diabetes

"The real reason for gestational diabetes (GD) is not known," he said.

"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 third trimester, there is a higher rise of these placenta hormones and typically, GD is assessed or discovered in the third trimester. This phenomenon is different for different individuals and most patients will not have GD," added Dr Chong.

Gestational diabetes risk factors

While it's important to note that GDM can happen to any pregnant woman, certain factors can increase the risk. Let's take a look at who might be at higher risk for developing gestational diabetes:

If you are overweight or obese

Women with a body mass index (BMI) of 23 kg/m2 and above have an increased risk of GDM.

Diabetes runs in the family

If you have a first-degree relative (parents, siblings, or children) with diabetes, your risk of developing GDM may be higher.

You had GDM during your last pregnancy or delivered a large baby

If you've had gestational diabetes during a previous pregnancy or you gave birth to a baby weighing over 4kg, you are at an increased risk of GDM in subsequent pregnancies.

Poor obstetric outcomes

Previous pregnancy complications typically associated with diabetes, such as stillbirth, can also raise the risk of GDM.

You are not physically active

A sedentary lifestyle, lacking regular physical activity, can contribute to insulin resistance and increase the risk of gestational diabetes.

Your blood sugar levels are high prior to getting pregnant

Prediabetes is a condition where blood sugar levels are higher than normal but not yet in the diabetes range. Women with prediabetes are at a higher risk of developing gestational diabetes if left untreated.

You have Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder that affects the ovaries and can lead to irregular menstruation, excessive hair growth, and obesity. Women with PCOS are at greater risk of developing gestational diabetes.

Remember, even if you are at higher risk, making healthy lifestyle choices and following medical advice can help manage gestational diabetes and ensure a safe and healthy pregnancy.

Signs and symptoms of gestational diabetes

According to Dr Chong, 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.

Is gestational diabetes considered a high-risk pregnancy?

Gestational diabetes is considered a high-risk pregnancy due to its potential risks for both the mother and the baby. Gestational diabetes mellitus (GDM) is a condition where high blood sugar levels develop in women during pregnancy because the body cannot produce enough insulin to meet the increased demands.

While most women with GDM, if well-controlled, have normal pregnancies and babies, inadequate management of the condition can lead to complications.

Effects of gestational diabetes

When a pregnant woman has gestational diabetes, her blood sugar crosses to high levels. Hence, her body produces more insulin to cope with this high blood sugar or glucose level. 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.

Impact of gestational diabetes on the baby

Here are some of the unwanted complications of GDM on the unborn baby:

• Excessive weight at birth > 4kg (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 also 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 one per cent of women without the condition.
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Dr Chong adds,

"Often gestational diabetes (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."

How is gestational diabetes diagnosed?

During pregnancy, all expectant mothers should undergo screening for GDM with an oral glucose tolerance test (OGTT) between 24 and 28 weeks. Early detection allows for appropriate treatment to reduce potential risks to both the mother and the baby.

You will need to fast for at least eight 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 one hour, two hours, and possibly three hours later. Your doctor will use your test results to find out whether you have gestational diabetes.

Treatment for gestational diabetes

The cure for gestational diabetes involves keeping your blood sugar levels under control. You can do this by:

• Blood sugar monitoring: Regularly check blood sugar levels using a glucometer. This helps track how well the treatment plan is working and allows adjustments if needed.
• Meal planning: Work with a dietitian to create a personalised meal plan that meets your nutritional needs while keeping blood sugar levels stable. 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.
• Oral medications: Occasionally, oral medications may be prescribed to help manage blood sugar levels. These are usually considered when lifestyle changes alone are not sufficient.
• Insulin therapy: In some cases, insulin injections may be necessary to control blood sugar levels effectively. Your healthcare provider will guide you on the right dosage and administration.
• Regular checkups: Attend regular prenatal checkups with your healthcare team, including obstetricians and endocrinologists, to monitor your pregnancy and diabetes progress.

Giving birth with gestational diabetes

Regular ultrasound scans will be conducted to monitor the baby's growth and well-being during pregnancy. Your healthcare team will work with you to determine the best time and type of delivery based on your blood sugar control and the baby's growth.

After delivery, continue to monitor blood sugar levels and attend follow-up appointments to ensure your blood sugar returns to normal levels.

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 a pregnant 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, ie 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.

Remember, with proper treatment and management, most women with gestational diabetes can have a healthy pregnancy and give birth to healthy babies. If you are worried that you are high-risk for this condition, do not hesitate to consult your doctor.

ALSO READ: Pregnancy insomnia: Why you're not sleeping

This article was first published in theAsianparent.