Gestational diabetes: Pregnant mom preparing healthy meal

What is Gestational Diabetes?

Before we tackle measures to manage gestational diabetes in Singapore, let’s first get a clear idea of what it is. Gestational diabetes mellitus (GDM) is a condition where mothers experience high blood sugar during pregnancy which usually disappears after giving birth1. While it is most common during the second and third trimester, it can occur at any stage of pregnancy.

Diabetes during pregnancy or GDM happens when the body is unable to produce an adequate amount of insulin, a hormone responsible for managing blood sugar levels. This causes blood sugar levels in the body to rise leading to gestational diabetes.

While any mother during pregnancy is at risk of developing GDM, those above 35, overweight, and/or have a history of diabetes are at greater risk. One out of five women develop GDM or diabetes during pregnancy, so it is advised for mothers to get tested from the 24th week of their pregnancy onwards2.

Some complications that might develop during and after childbirth due to gestational diabetes are, but not limited to3:

  • Excess growth (macrosomia)

  • Respiratory distress syndrome

  • Premature delivery

  • Low blood sugar

  • Increased risk of stillbirth

  • Type 2 diabetes later in life

In addition, mothers who have diabetes during pregnancy can also face these complications3:

  • High blood pressure

  • Future case of diabetes

Managing Gestational Diabetes

Mothers can manage gestational diabetes by monitoring blood sugar levels. They can do this by adopting a healthier diet and regular physical activity4. These three things make sure that blood sugar levels don't get too high during pregnancy.

Monitoring Gestational Diabetes

Mothers who have gestational diabetes or diabetes during pregnancy need to constantly monitor their blood sugar levels. Doctors or health care providers might require pregnant women to read their blood sugar levels four or more times in a day. This is usually done first thing in the morning and after meals to ensure that blood sugar levels stay in an acceptable range5. Frequent visits to the hospital for check-ups might also be in the books depending on the doctor’s assessment.

Adopting a Healthier Diet

For pregnant women with gestational diabetes or diabetes during pregnancy, a healthy diet is crucial in curbing the effects and complications that might arise. One can choose a balanced diet with a variety of healthy foods to help manage gestational diabetes6.

These are some dietary steps to manage GDM or diabetes during pregnancy7.

Choose healthier carbohydrates

  • The kind of carbohydrates consumed play a huge role in blood sugar levels. Mothers need to be conscious with the amount and quality of carbs they take in to keep gestational diabetes in check. Some healthy options are whole grains, fruits, vegetables, beans, and lentils. It is also ideal to avoid white bread, white rice, and highly-processed cereals.

Avoid too much milk

  • Mothers who drink too much milk might experience their blood sugar levels rising10. You may also be advised to avoid maternal milk while managing gestational diabetes or diabetes during pregnancy.

Cut back on free sugar

  • For mothers with gestational diabetes or GDM, water might be a better alternative than drinks that contain high sugar levels. Trying out low or zero calorie sweeteners, or artificial sweeteners might be better to manage blood sugar levels.

Manage portion sizes

  • This will help manage weight gain and keep blood sugar levels to an acceptable amount.

Choose better snack options

  • Snacks like yogurt, nuts, seeds, or fruits are better options than chocolates or cookies in managing gestational diabetes.

Avoid diabetic foods

  • Be mindful of the labeling of certain foods. They might not be suitable for diabetics.

Understand the Glycemic Index (GI)

  • By understanding the glycemic index, mothers can choose better options such as carbohydrates that rate lower in GI to effectively manage diabetes during pregnancy.

Weight Management

  • While it is normal to gain weight during pregnancy, mothers with gestational diabetes or GDM should pay closer attention to gaining too much weight as this may lead to complications down the line.

Physical Activity

Exercises can bring about positive effects to women who have gestational diabetes8. While there are no specific exercise guidelines or programs for pregnant women, some recommendations are still advised for diabetes during pregnancy. Pregnant women should try to fit in 30-60 mins worth of light to moderate exercise at a minimum of three times a week. Exercises should be focused on resistance and aerobics as these are most suitable for pregnant women to protect themselves from gestational diabetes. With this in mind, pregnant women should avoid activities that might be too strenuous such as contact sports and lifting weights. If in doubt, it would be best to seek advice from healthcare providers.

It is important to note that blood sugar levels may rise in the short term since physical activity can cause the body to release stored glucose. While blood sugar levels should stabilize a while after exercise, it is still important to closely monitor this just to be sure. Mothers in doubt can always reduce the intensity and increase the length of their work outs9.

Medication to Avoid Gestational Diabetes

To protect yourself from gestational diabetes or diabetes during pregnancy, doctors might prescribe medication. This happens if exercise and diet changes are not enough. Insulin shots or oral medication might be given to mothers to reach their blood sugar level goals5.

For mothers who are on medication and worried about gestational diabetes, they can talk to their healthcare providers. This is because some of these dietary options and exercise tips might not apply to them during medication

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Expert Resource:
Dr. Raymond Choy Wai Mun
(MCR 18097A)
MBChB (UK), Aviation Medicine (Singapore)


REFERENCES:

1. Overview: Gestational Diabetes ( 2019 ) Retrieved August 13, 2020 from:
https://www.nhs.uk/conditions/gestational-diabetes/#:~:text=Gestational%20diabetes%20is%20high%20blood,the%20second%20or%20third%20trimester.

2. Gestational Diabetes: What you Need to Know ( 2016 ) Retrieved August 14, 2020 from:
https://www.healthhub.sg/live-healthy/1606/gestational-diabetes-what-you-need-to-know

3. Guide 3: Keeping Gestational Diabetes in check ( 2019 ) Retrieved August 13, 2020 from:
https://www.healthhub.sg/live-healthy/1700/guide-3-keeping-gestational-diabetes-in-check

4. Managing Gestational Diabetes ( n.d. ) Retrieved August 13, 2020 from:
https://www.diabetesaustralia.com.au/managing-gestational-diabetes

5. Gestational Diabetes ( n.d. ) Retrieved August 14, 2020 from:
https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/diagnosis-treatment/drc-20355345

6. Gestational Diabetes Diet ( n.d. ) Retrieved August 14, 2020 from:
https://medlineplus.gov/ency/article/007430.htm

7. What Can I Eat with Gestational Diabetes ( n.d. ) Retrieved August 14, 2020 from:
https://www.diabetes.org.uk/diabetes-the-basics/food-and-diabetes/i-have-gestational-diabetes

8. Exercise Guidelines for Gestational Diabetes Milletus ( 2015 ) Retrieved August 14, 2020 from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515443/#:~:text=It%20is%20recommended%20that%20women,30%2D60%20min%20each%20time.&text=Core%20tip%3A%20Exercise%20has%20been,gestational%20diabetes%20mellitus%20(GDM).

9. Diabetes Management and Exercise in Pregnant Patients with Diabetes ( 2005 ) Retrieved August 14, 2020 from:
https://clinical.diabetesjournals.org/content/23/4/165.full

10. Dietary Recommendations for Gestational Diabetes ( n.d. ) Retrieved August 14, 2020 from:
https://www.ucsfhealth.org/education/dietary-recommendations-for-gestational-diabetes