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Parent Hub: We're Expecting - Gestational Diabetes

From pregnancy to raising a teenager, learn the ins and outs of raising a healthy child in this one-stop pregnancy and parenting platform for health information.

What you should know about

GESTATIONAL DIABETES

Gestational diabetes mellitus (GDM) is a type of diabetes that can develop during pregnancy.

GDM happens when the mother’s body cannot produce enough insulin to meet the extra needs in pregnancy or when insulin is not used effectively due to natural bodily changes occurring in pregnancy. This condition is common and can happen to any pregnant women. Most women usually recover after delivery, but it is still associated with an increased risk of developing pre-diabetes or diabetes in the future.

With screening and care, GDM can be detected early and with management, you can have a healthy pregnancy.
Detecting Gestational Diabetes Early

SCREENING & DIAGNOSIS

GDM screening is important for all pregnant women

If GDM is uncontrolled, expectant mothers will have a higher risk of developing complications during pregnancy and babies are also at risk of growth disorders.

What to expect when you’re diagnosed with GDM

Many expectant mothers diagnosed with GDM will experience mixed emotions. Some may feel surprised, others may feel anxious or even guilt. It is important to know that having GDM is not your fault as it can develop in any pregnant woman. Share your concerns with your doctor, diabetes nurse educator and dietitian at your appointments. In the meantime, check out these commonly asked questions and answers on what to expect when you are diagnosed with GDM.

What is GDM?

Blood sugar analysis report card.

GDM happens when the blood sugar levels are higher than normal during pregnancy. It occurs when the mother’s body is unable to produce enough insulin (a hormone that controls sugar levels), or is unable to respond to insulin adequately, in order to meet the extra demands of pregnancy. GDM commonly arises in the second and third trimesters when such demands are higher.

GDM goes away six weeks after the baby is born.

In Singapore, GDM is very common and affects 1 out of 5 pregnant woman. Most of the time, GDM goes away by six (6) weeks after the baby is born. Some, however, may be found to have diabetes or pre-diabetes and require further follow-up. Even if your glucose test is normal at 6 weeks after delivery, women with GDM remain at an increased risk of developing diabetes mellitus in the future.

GDM goes away six weeks after the baby is born.
4 Steps to Keep Your GDM

UNDER CONTROL

Monitoring your blood sugar

Monitoring your blood sugar levels throughout your pregnancy is a key part of GDM management. Regular monitoring allows you to feel more confident about managing diabetes as you understand how your lifestyle (e.g. diet, physical activity levels, stress) will affect your blood sugar levels.

How do I test my blood sugar levels?

Step-by-Step Guide (PDF)

Control Starts with a Healthy Balanced Diet

A healthy diet plan comprises well-balanced, healthy meals. This means you should aim to eat from the different food groups at every meal. Use My Healthy Plate as a guide to achieve this!

* The content in this section is intended for informational purposes only and does not substitute professional medical advice. You should consult your Doctor and Dietitian for personalised nutrition care plan.

Ask the Expert

Medical professionals from local maternity hospitals answered some of your commonly asked questions.

I eat out most of the time. What should I look out for?

Making food choices wisely is essential to manage your GDM if you eat out often. In general, use My Healthy Plate to remind yourself to include a large serving of leafy or non-starchy vegetables.

Whenever possible, choose wholegrain choices that are not cooked in additional fats and sauces. Additionally, choose grilled, stir-fried, steamed, or soup options. Avoid deep-fried, creamy dishes with excess gravy.

You may also look out for Healthier Dining Programme (HDP) logo displayed on stall fronts to help identify stalls that offers healthier options.

I am not allowed to snack at work. What do you suggest I do?

Having healthy tea breaks between meals are important to manage blood sugar levels as they help to curb hunger and prevent overeating during main meals. You could keep small packets of UHT low-fat milk or other calcium-rich dairy alternatives. They're convenient and also a great way to meet your calcium requirement.

You may also need to seek understanding from your supervisor/boss and colleagues that a short 5-minute snack break is essential for managing GDM during your pregnancy.

How can I monitor my blood sugar and diet if I’m doing
shift work and tend to have irregular meal times?

If possible, try to have your meals at the same time while keeping a gap of 2 to 4 hours between meals and snacks. Avoid going too long (more than 5 to 6 hours) without food, and always have some ready-to-eat snacks with you. Fresh fruits, a small packet of nuts, packets of UHT low-fat milk, wholemeal crackers, and biscuits are convenient options. Additionally, you can also perform blood sugar monitoring during your off days.

Talk to your healthcare team for further advice and support, especially if you are on insulin.

I have strong cravings for sweet and fried food, and I get hungry very quickly. How can I manage these cravings?

Most times, food cravings occur during emotional and stressful periods. Having regular mealtimes can also help to reduce food cravings and the tendency to binge eat when you feel hungry.

Here are other things you can also try when you have a craving or hunger pang:

  • Ensure that your main meals are well-balanced with adequate protein- rich foods.
  • Take time to enjoy your meals instead of rushing through them, as it can help you feel more satisfied and reduce food cravings.
  • Drink water or a suitable beverage as thirst can sometimes be mistaken as hunger or cravings.
  • Prepare some carrot and cucumber sticks, or cherry tomatoes as chewing on these may help to satisfy your hunger pangs.

No matter how strict I am with my diet, my blood sugar level still fluctuates. It's frustrating because I feel like I'm doing everything right, but sometimes my glucose readings are normal and other times they're sky-high. What should I do?

There are many reasons why your blood sugar levels may fluctuate throughout the day. The most common causes include food intake (the time, type, and amount of food eaten), the amount of physical activity you do, medication, emotional stress, and excitement or hormonal changes.

Certain foods may be causing your blood sugar levels to spike. Keep track of what you are eating and identify the foods that have the biggest effect on your blood sugar levels, then adjust your diet accordingly.

The hormonal and biochemical changes occurring later in pregnancy can also make blood sugar levels increasingly difficult to control. If an optimal diet is already in place, the doctor may recommend medication treatment to help reduce risks to the pregnancy and your baby. Talk to your healthcare team for further advice and support.

What does a one-day GDM diet look like?

There is no one-size-fits-all meal plan for expectant mothers with GDM. When planning your meals, distribute your carbohydrate intake regularly and consistently throughout the day and emphasise on choosing good quality nutrient-dense carbohydrate choices.

You can use My Healthy Plate to plan your meals. The following Sample Meal Plan is provided as a guide, but how much you should eat depends on your lifestyle and blood sugar levels. You are encouraged to schedule an appointment with a dietitian to get an individualised GDM meal plan and to address your specific nutritional needs.

I have gestational diabetes. Will fasting during my pregnancy affect my baby?

Fasting can affect blood sugar levels which increases the risk of hypoglycemia and these conditions can affect the health of both the mother and the pregnancy. For expectant mothers with gestational diabetes, fasting is considered high risk. To be on the safe side, doctors generally advise against fasting. If you have gestational diabetes and are considering fasting during Ramadan, we strongly encourage you to talk to your doctor beforehand to get a thorough assessment of the risks and receive guidance on meal planning and self-monitoring of blood sugar levels before the start of Ramadan.

Exercise is Good for You and Your Baby

When you are physically active, the muscles in your body will help to absorb the sugar in the blood.
This helps you stay within the recommended sugar levels.

In general, here are the guidelines for expectant mothers:

Discuss with your doctor on the total time to be spent on exercising and the appropriate intensity of the exercise.

Ease into your physical activity routine progressively. Listen to your body and seek your doctor's recommendation on suitable activities if you are unsure of how to start.

Take safety precautions before and during exercise and follow these physical activity guidelines for expectant mothers.

Before you start exercising, check with your doctor.

As every case of GDM is different, it is crucial to seek advice from your doctor before starting any exercise programme. Your doctor will consider your physical activity history and fitness level as well as the severity of the GDM, medication regimen, and level of control over GDM. The appropriate level of exercise can vary quite significantly from one mummy to another.

Ways to Stay Active Throughout the Day!

Stay Safe Before, During and After Exercise!

Start slow with low-impact physical activities and increase gradually to keep your phase during exercise

Start slowStart with low-impact physical activities and increase the intensity gradually as tolerated

Stay safe from activities with high risk of falling

Stay SafeAvoid participating in activities which involve physical contact or a higher risk of falling

drink water frequently to stay hydrated

Keep hydratedDrink fluids before, during and after exercising

monitor the blood sugar levels during and after exercising

Monitor blood sugar levels before, during and after exercising.

  • If levels are too low, take a small healthy snack or sugar containing sweets before exercising to prevent hypoglycaemia (i.e low blood sugar).
  • If levels are too high, it may not be safe to exercise. If blood levels are persistently high, see your doctor earlier.
Stop exercising if you feel unwell

Stop exercising if you feel unwell(e.g. dizzy, nausea, any chest tightness or discomfort, severe shortness of breath, regular painful contractions or vaginal bleeding)

Try to set realistic expectations for yourself and be mindful of your thoughts and emotions.

For expectant mothers with GDM, having to monitor blood levels consistently and make the necessary lifestyle adjustments can be stressful at times. This is why it is even more important to take good care of your own mental well-being!

When Emotions Run High

When faced with the diagnosis of GDM, it can be easy to feel a sense of guilt or shame. It is important to remember that developing GDM is not your fault, and there are steps that you can take to manage your diagnosis while also maintaining a healthy state of mind.

Try to set realistic expectations for yourself and be mindful of your thoughts and emotions.
Try to set realistic expectations for yourself and be mindful of your thoughts and emotions.

Try to set realistic expectations for yourself and be mindful of your thoughts and emotions. This means being aware of what you can accomplish now and keeping things in perspective. You may not be able to control every aspect of your life while also managing GDM, so it is important to manage any feelings of frustration or anxiety that arise as a result. Do the things that will help you relieve stress.

Here are 5 ways to care for your mental well-being:

Understanding GDM is a first and necessary step to managing and living well with the condition.
#1 Be informed

Having a general understanding of GDM from reputable and reliable sources, and your healthcare team (e.g. Doctor, Diabetes Nurse Educator, Dietitian) is the first and necessary step to manage with the condition.

Ask your doctor when you have questions about managing your diabetes
#2 Ask your doctor when you have questions

As you learn about GDM, you might feel overwhelmed with all the information and new skills you need to learn to manage your diabetes. Note them down and ask your doctor at the next appointment.

Let your family and friends know of your condition and share with them how you feel.
#3 Share with your family and friends

Let your family and friends know of your condition and share with them how you feel. They can offer you support, new perspectives, practical tips, and more. You do not have to go through this alone.

Having real-life connections with other women who are also dealing with GDM can provide invaluable tips and practical support
#4 Join support groups

Having connections with other women who are also dealing with GDM can provide invaluable tips and practical support, in addition to tried-and-tested ideas to cope with the situation. It's also immensely reassuring to know that others share your experiences!

Having GDM management plan will keep you organised and focused, giving you a sense of control.
#5 Make a GDM management plan

Having a plan will keep you organised and focused, giving you a sense of control. You can always start small and grow your plan gradually. Here are some tips to kickstart:

  • Set realistic goals by thinking about what you can do to manage GDM. For example, allocate additional time each week for some physical activities. Or it could be ensuring you have a balanced and healthy breakfast each day.
  • Make time for relaxing activities such as deep breathing and do things that you enjoy, such as engaging in hobbies, catching up with friends etc.

Giving Love and Support to Expectant Mothers

A strong support network can make all the difference, especially when expectant mothers feel lost or down about their GDM diagnosis. Husband and family members, such as grandparents, all have important roles to play in providing support. Support can take many forms, including emotional, physical, and practical. Here are 5 ways to support mothers with GDM:

Give love and support to expectant mothers.
Giving love and support to expectant Mothers is incredibly powerful
#1 Show your care and support

Knowing someone truly cares is incredibly powerful. When an expectant mother is upset, anxious, or feeling low, let her know you are there for her and want to help. Try saying, "This must be hard for you, I am here for you whenever you need a listening ear." Be genuine and empathetic.

Listening to mommy and giving her space to open up is one of the best ways to show your support.
#2 Lend a listening ear

Sometimes the best way to support the mother is simply by listening. Giving her the space to open up and share their emotions without interruptions and judgements can be incredibly healing.

Take the time to learn about GDM
#3 Be understanding

Take the time to learn about GDM, such as the complications and management strategies. Then, offer the practical support whenever she needs.

Help her stay motivated by joining her diet plan.
#4 Join in the diet plan

When it comes to maintaining a healthy diet, the power of two trumps the power of one. Help her stay motivated by joining her diet plan. Take a look at the dietary advice to understand her nutritional needs. Additionally, when dining with her, avoid indulging in foods which she has to abstain from. A healthy diet for her can also be a healthy diet for you.

stick to an active lifestyle throughout the pregnancy.
#5 Get active together

Offer to go for a walk or take a yoga class with her. She will be beaming with delight knowing you are there to help her kickstart and stick to an active lifestyle throughout the pregnancy.

PostPartum Care For

MUMMY & BABY

What to expect after delivery?

After delivery, one of the most important aspect is to check if your blood sugar levels have returned to normal. Without the demands of pregnancy, your insulin requirements will reduce and for most women, GDM will resolve. Breastfeed to reduce your risk of developing diabetes.

check if your blood sugar levels are back in the healthy range

To check if your blood sugar levels are back in the healthy range, you will be required by your doctor to take the 2-point OGTT at around 6 to 12 weeks after delivery.

Make time for this follow-up OGTT as it is key to detecting diabetes early.

If diabetes is not detected early or well-controlled, it can lead to serious complications of the kidney, eyes, blood vessels and nerves. It can also cause complications in your future pregnancies like increased risk of miscarriage, birth defects and an extra large or small baby.

When OGTT result is normal

You are recommended to screen for diabetes every 1 to 3 years.

In Singapore, compared with women who did not have GDM, women diagnosed with the condition:

  • Have a higher risk of developing GDM in future pregnancies; and
  • Are 12 times more likely to develop Type 2 diabetes within 5 years of delivery; and
  • Have a higher risk of developing Type 2 diabetes for the rest of their lives.

As such, mothers with GDM history will need to continue to stay vigilant.

When OGTT result is abnormal

When OGTT is abnormal, you may have pre-diabetes or diabetes. As such, it is important to have regular check-ups with your doctor. With active management, you may still keep your condition well-controlled.

For more information on diabetes management, refer to Diabetes Hub: Guide to Managing Diabetes.

Do's and Don'ts During Confinement

Do's and Don'ts During Confinement

Do’s

Do's during pregnancy Maintain a healthy balanced diet together with physical activity and mentall well being during pregnancy.

To be in the best possible shape physically and mentally, continue to stay on the same healthy, balanced diet that you maintained during your pregnancy.

This is especially important if you are breastfeeding as your nutritional status and dietary intake can influence the composition of your breastmilk, especially vitamins, minerals and fatty acids. By keeping yourself well-nourished, both you and your baby will be getting all the nutrition, vitamins and minerals to grow strong and healthy.

Make time for physical activity every day, even if it’s just a short walk or light exercise. Regular physical activity improves blood sugar control and boosts your mood and overall well-being. Aim for 150 minutes of moderate-intensity aerobic physical activity per week.

Prioritise your mental well-being by adjusting your expectations. Engage yourself in activities that can help you to relax and reduce your stress (e.g., taking a stroll), and stay connected with your loved ones. It is okay to reach out for support.

Don’ts

Don'ts during pregnancy

Expectant mothers with GDM may not be able to consume all the customary confinement foods. You should:

  • Avoid sweetened drinks (e.g. longan red dates tea) as these may cause spikes in your blood sugar levels . Any consumption of such drinks should be diluted so as to reduce sugar intake.
  • Avoid consuming too many calories to reach your pre-pregnancy weight more quickly (e.g. reduce the use of sesame oil and fatty meat).
  • Don’t engage in intense or strenuous exercise without the guidance of your doctor. Make sure you are engaging in safe and appropriate activities for your current health status and stage of pregnancy.
  • Don’t set unrealistic expectations. Keep things in perspective as you may not be able to control every aspect of your life while also managing GDM.
  • Don’t isolate yourself or neglect your social connections. Share your worries and concerns with your partner, family, friends or considering joining support groups. Lack of social support can lead to stress, which can impact blood sugar levels.

Reducing your baby’s risk of diabetes

Follow these guidelines to reduce your baby's risk of developing diabetes later on in life:

#1 Breastfeed your little one

Breastfeeding or breast milk can be the only nutrition your baby needs for the first 6 months.

When it comes to raising healthy babies, breastfeeding is one of the most important things mothers can do. Breast milk contains all the vital nutrients crucial for the baby's growth and development. It also provides powerful protective benefits against a wide range of health conditions including reducing the risk of diabetes for both the baby and the mother.

Breastfeeding or breast milk can be the only nutrition your baby needs for the first 6 months. After that, you can start to introduce solid food while continuing to breastfeed your baby.

#2 Practise responsive feeding

When breastfeeding, practise responsive feeding.

When breastfeeding, practise responsive feeding. Responsive feeding means tuning in to your baby's signals of hunger and fullness and responding appropriately. By doing this from a young age, you are helping your child to learn how to regulate his/her appetite and build a healthy relationship with food, which can help prevent childhood obesity.

#3 Instill healthy eating habits when you start your baby on solids

Instill healthy eating habits when you start your little one on solids

Healthy habits start young. Introduce a variety of nutritious, healthy food to your little one when they are ready for solids. Avoid using sweets as rewards or treats, as this can lead to unhealthy eating habits. Avoid introducing sugary drinks (e.g. fruit juices and canned drinks) to them. Instead, encourage them to drink water or milk (low-fat milk for children >2 years old). These habits form the foundation for a lifetime of healthy eating and hence reduce the risk of diabetes in future.

Reducing mummy’s risk of diabetes after delivery

Reducing mummy's risk of diabetes after delivery

Breastfeeding and maintaining a healthy weight and lifestyle are the best and proven way to reduce your risk of diabetes. This applies even if your postnatal OGTT results were normal. Here are some ways to reduce the risk:

Stay healthy with My Healthy Plate

use My Healthy Plate to guide your eating patterns.

Use My Healthy Plate to plan your meals. Check out these tips on how to make the most of My Healthy Plate to stay in good health and reduce your risk of developing diabetes.

Exercise every week

Regular physical activity helps you in maintaining a healthy weight.

Regular physical activity burns calories and helps you in maintaining a healthy weight. Ease into your physical activity routine progressively. Listen to your body and seek your doctor's recommendation on suitable activities. Try to aim for at least 150 minutes of moderate-intensity aerobic physical activity per week. You'll not only be able to manage your weight, but also have more energy to care for your growing child.

Aim for a healthy BMI

Actively monitor and manage your weight to stay within the healthy BMI range.

When you have a healthy BMI, you are at a lower risk of developing diabetes and a whole list of other health conditions. Actively monitor and manage your weight to stay within the healthy BMI range.

Be proactive

proactively go for blood sugar tests every 1 to 3 years to ensure early detection of any possible diabetes.

If you have plans to have another child or are currently in the early stages of your next pregnancy journey, get medical advice early. You should also proactively go for blood sugar tests every 1 to 3 years to ensure early detection of any possible diabetes.

Acknowledgements

The page has been endorsed by the following representatives, listed in alphabetical order by institutions.

  • A/Prof Daisy Chan
    Chairperson, Chapter of Neonatologists, College of Paediatrics and Child Health Singapore
  • Prof Tan Kok Hian
    Head and Senior Consultant, Perinatal Audit & Epidemiology, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital
  • A/Prof Tan Lay Kok
    Senior Consultant, Obstetrics & Gynaecology, KK Women's and Children's Hospital
  • Dr Moira Chia Suyin
    Consultant, Department of Paediatrics, KK Women’s and Children’s Hospital
  • Dr Han Wee Meng
    Head and Senior Principal Dietitian, Nutrition and Dietetics Department, KK Women's and Children's Hospital
  • Ms Adeline Kooh Seok Koon
    Asst Director, Nursing (Maternity), Mount Alvernia Hospital
  • Dr Angelia Chua
    Family Physician – Consultant, National Healthcare Group Polyclinics
  • Dr Teh Kailin
    Family Physician – Consultant, Medical, National Healthcare Group Polyclinics
  • Dr Ong Nyuk Shiew
    Family Physician- Associate Consultant, Medical, National Healthcare Group Polyclinics
  • Ms Wong Yuefen
    Principal Dietitian, Clinical Services, National Healthcare Group Polyclinics
  • Ms Lim Voon Hooi
    Chief Nurse, Nursing Services, National Healthcare Group Polyclinics
  • Prof Lee Yung Seng
    Group Director, Paediatrics, National University Hospital
  • Ms Ang Ming Hui
    Senior Dietitian, Dietetics Department, National University Hospital
  • Ms Janelle Pang Gin Ting
    Dietitian, Dietetics Department, National University Hospital
  • Ms Sarah Ho-Lim
    Assistant Director Of Nursing (Obstetrics & Gynaecology & NICU) / Advanced Practice Nurse, National University Hospital
  • Ms Jeannie Chen Sihua
    Advanced Practice Nurse, Nursing Department, National University Hospital
  • Ms Tan Guat Kian Elaine
    Nurse Clinician (Diabetes Care), Nursing Department, National University Hospital
  • A/Prof Chan Shiao-Yng
    Senior Consultant, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, National University Hospital
  • Ms Susan Kok
    Senior Asst Director, Nursing, Gleneagles Hospital, Parkway Pantai Group
  • Ms Helen Cruz Espina
    Senior Lactation Consultant, Raffles Hospital Pte Ltd
  • A/Prof Yong Tze Tein
    Head & Senior Consultant, Obstetrics & Gynaecology, Singapore General Hospital
  • Dr Dr Devendra Kanagalingam
    Senior Consultant, Obstetrics ＆ Gynaecology, Singapore General Hospital
  • Eunice Goh Ern Hui
    Principal Dietitian, Department of Dietetics, Singapore General Hospital
  • Ms Francine Tu Chen Chen
    Senior Staff Nurse, Perinatal Centre, Obstetrics & Gynaecology, Singapore General Hospital
  • Ms Fonnie Lo
    Asst Director, ParentCraft Centre (Clinical) and Lactation Consultant, Thomson Medical Pte. Ltd
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