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.
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.
Do I need to be
screened for GDM?
Why?
All expectant mothers* are
strongly recommended to go for GDM
screening. Compared to Western women, a
higher proportion of Asian women develop
GDM. As GDM often has no symptoms, it
is difficult for one to tell whether an
expectant mother has GDM, it is therefore
recommended to go for screening. With early
detection, you will get treatment earlier,
reducing
pregnancy complications and other health
risks for both the mother and the baby.
* Excludes expectant mothers
already known to have diabetes mellitus. If
you have a history of pre-diabetes, your
doctor may choose to do an Oral Glucose
Tolerance Test (OGTT) earlier
in pregnancy or get you started you on
self-blood glucose monitoring without an
OGTT.
Am I at risk of
developing GDM?
All expectant mothers have some
degree of risk of developing GDM, and most
of the time, there are no obvious symptoms
or indications of the condition.
Expectant mothers are at a higher
risk if they have:
Parents or siblings with diabetes
High BMI (Pre-pregnancy BMI > 23kg/m
2)
Excessive weight gain during pregnancy
A personal history of GDM in previous
pregnancy
Previous child weighing more than 4kg at
birth
Age ≥ 40 years
Hypertension
Previous poor pregnancy (obstetric)
outcomes that are usually associated
with diabetes, such as stillbirth
* Excludes expectant
mothers already known to have
diabetes mellitus. If you have a
history of pre-diabetes, your
doctor may choose to do an OGTT
earlier in pregnancy
or get you started on self-blood
glucose monitoring without an
OGTT.
Around week 24 to 28
of pregnancy with 3-point Oral
Glucose Tolerance Test (OGTT).
Normally screened
earlier in pregnancy, usually
with a 2-point OGTT.
If the results are
normal, the expectant mother
will then be screened again
between week 24 to 28 with
3-point OGTT.
If you are diagnosed with
GDM, be assured that the condition can be
managed with a healthy diet, regular
exercise, and medication (if needed). Most
importantly, work closely with
your healthcare team to keep your GDM under
control.
How is GDM
screened?
GDM is screened through the
3-point Oral Glucose Tolerance Test (OGTT),
conducted in the morning. An OGTT usually
takes around 2 to 3 hours to complete and
involves:
Taking the fasting blood sugar test
Consuming a 75g sugar drink within 5
minutes
Taking the blood sugar test again at one
and two hours later
The table below shows when GDM is
diagnosed. If any of your results are
higher, you could be diagnosed with GDM
after your doctor has done a holistic
assessment of your pregnancy
health.
Test
Description
Plasma
Glucose Level
Criteria
(mmol/L)
Plasma
Glucose Level
Criteria
(mg/dL)
Fasting
≥ 5.1
≥ 92
1-hour post OGTT
≥ 10.0
≥ 180
2-hour post OGTT
≥ 8.5
≥ 153
How to prepare
for GDM
Screening?
The test
should start early and be
completed in
the morning.
Maintain your
usual balanced diet in the days
leading up to the test. Going on a
diet or having a series of heavy
meals can make the test less
reliable and affect the OGTT
results.
Do not
perform strenuous physical activity
or exercise vigorously before or
during the test. Increased physical
activity will affect the blood sugar
levels.
Do not
consume food or drinks other than a
small amount of water for 8 to 10
hours before the test.
Do not eat,
drink, or smoke during the OGTT.
Do consult your doctor if you have reservations
about whether the test is right for you. Especially
if you are currently taking
medications or have had weight loss surgery in the
past.
What are the risks
of GDM
screening?
The OGTT is safe for the pregnant
mother and her fetus. The most common
discomfort is feeling nauseated or dizziness
from the sugary drink. In rare cases, the
drink may trigger vomiting.
If you experience any discomfort, inform
your healthcare professional and rest till
the feeling passes. Sometimes, the test may
have to be rescheduled.
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?
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.
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.
I have always
been eating
healthily and I exercise. Why do I still have GDM?
Having a healthy lifestyle helps
to lower but does not eliminate the risk of
the mother developing GDM; If diagnosed, it
also aids in keeping the GDM under control
during pregnancy.
A pregnant woman’s body undergoes
many changes to support the needs for the
development of a healthy baby. In GDM, your
body is not able to make some of these
healthy changes required
in response to being pregnant. This could be
due to several reasons such as pregnancy
hormones, insulin resistance, genetic
make-up, pre-existing medical conditions,
stress and
medications.
As such, the most important thing
now is to develop or continue the good
habits of eating healthily and
staying active (e.g. engaging in light
exercises) throughout your pregnancy
journey.
How does GDM affect
me and the
delivery?
Most expectant mothers with
well-controlled GDM can look forward to a
smooth pregnancy and normal vaginal
delivery.
When GDM is poorly controlled, it
can lead to complications such as:
Pregnancy-induced high blood pressure or
pre-eclampsia;
Premature delivery and babies born
before reaching their full term are more
likely to have health problems
immediately after birth and in the
longer term. These may include issues
with their lungs, heart and brain
development;
Increased risk of emergency cesarean
section during labour.
In some cases, the doctor might
recommend inducing labour rather than
waiting for labour to start on its own. This
usually happens when the pregnancy has
reached term (i.e. typically
between 38-39 weeks). It would be considered
if:
GDM is treated with medication;
Baby is expected to be large in size; or
Blood sugar level is not well-controlled
During labour, your healthcare
professional will monitor your blood sugar
levels closely. If necessary, they might
administer insulin to keep your sugar levels
under control for a
safe delivery. As your baby is at a higher
risk of low sugar levels, you are encouraged
to have skin to skin contact and start
feeding your baby as soon as possible after
delivery.
How does GDM affect
my baby?
When your blood sugar levels are
well-controlled, you can look forward to a
smooth pregnancy and delivery. However, in
cases where GDM is poorly controlled, your
fetus might be affected.
For instance,
The baby/babies may be larger. This
could result in a more difficult
delivery as the baby might be too big
for the birth canal. Hence, he/she might
sustain injuries (shoulder
dystocia, i.e. whereby the baby’s
shoulders may be stuck at the birth
canal) and brain damage.
In rare cases, it may also lead to
stillbirth (also known as intrauterine
fetal death), where the baby’s heart
suddenly stops beating whilst inside the
womb.
Increased risk of baby being admitted
into the neonatal unit for conditions
such as breathing difficulties, low
blood sugar, blood mineral imbalances or
neonatal jaundice.
The baby may also be at greater risk of
becoming overweight or developing
diabetes later in life.
Fortunately, with good sugar
control and treatment, most mothers with GDM
have smooth deliveries and healthy babies.
How does GDM affect
my pregnancy
journey?
The treatment of GDM varies,
depending on the result of the OGTT and the
progress of your self-blood sugar
monitoring. In general, here is what you can
expect:
Self-monitoring
of your blood sugar levels at different
timepoints
throughout the day (before meals, 2
hours after meals and at bedtime), on at
least two (2) days a week
More frequent doctor visits to monitor
your baby’s growth, as well as your own
blood sugar levels and blood pressure;
Sometimes, the diabetes condition
may worsen as pregnancy progresses, and you
may find that lifestyle measures are no
longer adequate to achieve good blood sugar
control. Your doctor
may then recommend treatments such as oral
medication (e.g. metformin) or insulin for
the remaining days of your pregnancy
journey. For some mothers, your doctor may
recommend
such medication sooner if the OGTT test
shows a particularly high reading or blood
sugar is not well controlled early in
monitoring.
You may also want to monitor your
baby's movements during the day. If you
suspect that your baby is moving less than
usual, it is advisable to consult your
doctor.
What are the
long-term risks of
GDM?
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, it is important to keep
an eye on your health and have regular
check-ups with your doctor. You are also
encouraged to breastfeed your baby, maintain
an optimal weight (normal
BMI) and try to maintain a healthy lifestyle
which includes eating a healthy diet and
exercising regularly. All of these can help
to reduce the risk of developing Type 2
diabetes.
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.
What is blood sugar
monitoring?
Blood sugar monitoring measures
your blood sugar at the point of time you
are doing the test. It can be performed
using a blood glucose meter (also known as
glucometer) anywhere;
at home or at work.
What
equipment do I need to monitor my blood glucose levels?
You will
need the following
items:
Glucometer
Test Strip
Lancet Device and
lancets
(needle)
Clean Tissue Paper
When should I test
my blood sugar
levels?
Your doctor will let you know how
often you should test your blood sugar
levels^. Generally, you will test 1 to 2
full days per week (depending on your
control), at the following
7 time-points. On both days, you will test
immediately before and 2 hours after*
breakfast, lunch, and dinner; and once at
bedtime.
On the right is a sample of a
blood monitoring schedule.
^
Your doctor may recommend/advise you to
monitor more frequently when there are
concerns or when you have commenced on
insulin.
* 2 hours after the first mouthful.
^ Your doctor may
recommend/advise you to monitor more
frequently when there are concerns or when
you have commenced on insulin.
* 2 hours after the first mouthful.
What blood sugar levels
should I aim
for?
Every pregnancy is unique. Do consult
your doctor on the appropriate blood sugar levels
for your pregnancy. In general, the
ideal targets for expectant mothers
with GDM are:
Pre-meal
and
bedtime
2
hours
post-meal
If you are not on any diabetes
medication and your sugar levels are just slightly
below these ranges and you are feeling well, this is
not of concern. However, if you are worried, talk to
your doctor.
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!
Setting and achieving your diet goal
Diet
goal: Maintain the individualised
optimal weight gain recommended by your
doctor or dietitian while keeping your blood
sugar levels within the targeted levels.
Work with your dietitian or
diabetes nurse educator to achieve your diet
goal while obtaining the adequate nutrition
for you and your baby to support optimal
growth and development
of your baby.
Sometimes, even with a good
diet and optimal weight gain, you may still
need the medication to control your blood
sugar. While on medication, continue to stay
on a healthy diet. Your
diet goal still matters!
4 steps to control your
blood sugar
levels
#1 Plan your
meals and snacks 2
to 4 hours apart
Space out your daily intake by having
3 small meals (breakfast, lunch, and dinner) and
3 healthy snacks (mid-morning, mid-afternoon,
and bedtime) throughout a day. Have about 2 to 4
hours
interval between your meals and healthy
snacks.
Spreading out your food intake
over smaller portions will help to prevent
blood sugar spikes and gives your blood
sugar levels enough time to normalise before
the next meal.
1
serving of snack is
equivalent to:
1 slice of
wholemeal/wholegrain bread*
3 square pieces (25g)
plain/wholewheat crackers*
3 tablespoon of oats (before
cooking)
½ medium bowl cornflakes or
branflakes
1 piece of 4” pancake
1 small, plain scone
1 mini chicken/cheese bun*
1 small chappati (6”
diameter/saucer-sized)* or 1
idli
1 soon kueh/steamed popiah
(no sweet sauce)
1 chwee kueh (less oil)
1 bowl original, plain
beancurd (no sugar)
½ cup of corn (no butter or
margarine)*
½ cup cooked chickpeas or
hummus
3 tablespoons red/green
beans (boiled in water,
unsweetened)*
½ cup mashed potato with 1
tbsp gravy
1 egg-sized steamed sweet
potato or yam
1 serving of milk or yoghurt
1 serving of fruit*
1 small handful of plain,
unsalted baked nuts*
*Wholegrain or high
fibre products.
Source: KK Women's and Children's
Hospital.
#2 Control
your carbohydrates
Carbohydrates
(carbs) act as a source of fuel for you
and your baby and are an essential part of a
balanced meal.
Although carbs are broken down
into sugar during digestion and absorbed
into the bloodstream, resulting in an
increase in blood sugar level, there is no
need to cut out carbs completely.
Instead, control
your intake of carbs and avoid
large meals or meals with too much carbs, as
they can cause your blood sugar level to
rise. You may also consume wholegrain
options which can slow the absorption into
your bloodstream and avoid
sugar spikes.
1
serving of wholegrains is
equivalent to:
2 slices of wholemeal bread
(60g)
½ bowl* of wholegrain
noodles, beehoon or
spaghetti (100g)
½ bowl* of brown or red rice
(100g)
2 wholemeal chapatis (60g)
⅔ bowl* of uncooked oatmeal
(50g)
When consuming starchy
vegetables (i.e., potatoes, sweet
potatoes, corn, tapioca, pumpkin and
yam), do take note that other forms of
carbohydrates in the meal should be
reduced.
Source: HPB Nutrition Hub.
#3 Choose
unsweetened drinks
Drinking water is the best way to
stay hydrated. You can spruce things up by
adding fresh fruits and vegetables. Flower tea
and other unsweetened drinks are other healthy
drink options
as they contain little or no calories and no
added sugars.
Avoid
sweet drinks (including fruit juice) as they
could cause your blood sugar levels to
spike. They also contain calories that
provide minimal nutritional benefits which
can make
it harder for you to maintain your optimal
weight during pregnancy.
#4 Figure out
what foods suit
you
Keep track of your food intake on
days you are testing your blood sugar levels.
This way you'll be able to associate your food
intake with your blood sugar levels and
understand how your
body responds to different types of food.
For
example, when you test your blood sugar
levels 2 hours after a meal and the reading
is higher than the ideal reading recommended
by your doctor, do review the foods that you
have
just eaten as those are the foods you want
to eat less of or avoid altogether.
5 healthy eating
tips for GDM
Management that you must know
The GDM healthy eating nutrition plan
follows the principles of
My Healthy
Plate.
#1 Choose
wholegrains
Wholegrains are rich in fibre,
vitamins and minerals. When wholegrains are
digested, the sugars are absorbed into the
bloodstream at a slower
rate. This will result in a more stable blood
sugar level.
Click on the images below to find out
what is the healthier option
#2 Increase
fibre intake
Fibre not only makes you feel fuller
and more satiated, but it will also help in
slowing down carbohydrate digestion and keeping
your blood sugar levels steady. Try boosting
your fibre
intake by filling half of your plate with leafy
and non-starchy vegetables, and include a
serving of
fruit
with your meal.
1
serving of fruit is
equivalent to:
1 small apple, orange, pear or mango
(130g)
1 medium banana (120g)
1 wedge of papaya, honeydew,
watermelon or pineapple (130g)
½ medium grapefruit, persimmon,
dragonfruit, guava
4 small or 2 medium
jackfruits/cempedak seeds
1 slice pomelo
2 small or 1 medium plum
6 rambutans, duku or langsat
10 lychees, longans, small grapes or
large strawberries
¼ large pomegranate (4” diameter) or
½ cup pomegranate seeds
12 cherries
¾ cup blueberries
1 large (medjool) or 3 small dried
dates (ajwa)/prunes
Source: HPB Nutrition
Hub and KK Women's and Children's
Hospital.
#3 Eat
protein-rich foods in
moderation
Protein is essential for
supporting the growth and development of healthy
babies, as well as for maintaining muscle and
body tissues. The requirements
for protein intake will vary depending on
several factors such as, your pregnancy
trimester, your weight and weight gain progress,
and your level of physical activity.
If you
are concerned about your protein intake,
your dietitian will be able to advise you on
suitable portion sizes to meet your
individual protein needs.
1
serving of protein of
equivalent to:
2 egg whites (40g)
2 tablespoons tuna in
water/brine
1 slice cheese (reduced fat)
or ¼ cup pastuerised ricotta
or cottage cheese (low fat)
1 dessert spoon nut butter
(no sugar added)
1 palm-sized piece of meat,
fish or poultry (90g)
¾ cups* of cooked pulses
(peas, beans, lentils)
(120g)
2 small blocks of soft
beancurd (170g)
5 medium prawns (90g)
2 cups of reduced/low fat
high calcium milk (500ml)
*250ml cup
Source: HPB Nutrition Hub and KK
Women's and Children's Hospital.
#4 Choose
healthy fats
Fats will slow down digestion and
delay sugar absorption. Hence, it can cause
one’s blood sugar levels to remain high for a
longer period. Fats are also high in calories
which can lead
to weight gain if consumed excessively. However,
this does not mean that it should be excluded
from your diet altogether. Rather, it is
important to make smart
choices!
Cooking
at home
Choose olive,
canola, groundnut, soy bean
and sunflower oils
Choose dishes that are
stir-fried,
steamed, grilled, or baked
over oily foods or dishes
that are deep-fried
Other
tips
Choose lean
meat, fish or beans and bean
products like tofu or tau
kwa
Remove skin
and visible fat from poultry
and meat
Opt for high calcium,
low-fat dairy products like
yoghurt, cheese or milk
* Products with the
Healthier Choice Symbol are healthier option
as compared to those in similar food groups.
Do note that all foods that are consumed in
excessive amounts can cause
weight gain. Hence, do remember to consume
all foods in moderation, even when you are
consuming healthier choice products.
#5 Watch your
intake of sauces,
gravies and use salt in moderation
Sauces and gravies might contain
hidden sugars that can add to your carbohydrate
intake and increase blood sugar levels. Regular
consumption of sauces and gravies also adds
unneeded calories
which can make it hard for you to maintain your
optimal pregnancy weight.
While salt itself does not have
any direct effect on your blood sugar
levels, consuming too much salt can lead to
high blood pressure over time.
To reduce your intake of
hidden sugars and salt:
Instead of ready-made or commercial
sauces and gravies, use natural
alternatives such as herbs and
spices or cook with garlic, ginger,
shallots, and onions to add flavour
to your meal.
If you must use sauces and gravies,
choose those with the Healthier
Choice
Symbol. They're lower in
sugar and salt!
* 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.
Sample Meal Plan
(For servings
refer to “My Healthy Plate” serving
sizes)
Breakfast
1 cup of milk or other high
calcium alternative
beverage1 serving of
wholegrain
bread1 serving of egg
or other protein
alternative
Mid-morningsnack
1 cup of milk or other high
calcium alternative
beverage or1 serving
of whole
fruit
Lunch
2 servings of brown rice or
alternatives1 serving
of meat or
alternatives1-2
servings of non-starchy
leafy vegetables1
serving of whole
fruit (optional)
Mid-afternoonsnack
1 serving of wholegrain crackers
(optional)1 cup of
milk or other high
calcium alternative beverage or1
serving of whole fruit
Dinner
2 servings of brown rice or
alternatives1 serving
of meat or
alternatives1-2
servings of non-starchy
leafy vegetables1
serving of whole
fruit (optional)
Bedtime
1 cup of milk or other high
calcium alternative
beverage or 1 serving
of whole
fruit
Step 3: Maintain an active lifestyle
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!
Keep Moving
6
ways to engage in activities of any intensity throughout
the day!
Doing some housework or going grocery shopping is
a great form of exercise too.
Go grocery shopping to clock some steps
Have fun with your littles ones in the park
Do some housework to stay active at home
Go for a stroll with your partner after meals
in the evening
Decorate the baby’s nursery
Go window shopping in the neighbourhood
Hit 150
5
ways to engage in at least
150 minutes of moderate-intensity aerobic
physical activity per week!
Take a brisk walk to get your heartbeat up
Go for a swim! It’s a safe, low-impact
aerobic activity
Pedal up a sweat on a stationary bicycle
Join a modified yoga or pilates class
Go for a jog outdoors to enjoy the fresh air
Build Strength
3 ways to incorporate
muscle-strengthening and resistance-training activities!
Core strengthening activities and pelvic muscle
training may be performed regularly to strengthen the
trunk
and reduce the risk of
urinary incontinence.
Adding gentle stretching may also be helpful.
Add body weight exercises like lunges and
squats to your exercise routines
Include exercises with light weights or
dumbbells
Use resistance bands to build strength
Stay
Safe Before,
During and After Exercise!
Start
slowStart with low-impact physical
activities and increase the intensity gradually as tolerated
Stay
SafeAvoid participating in
activities which involve physical contact or a higher risk
of falling
Keep
hydratedDrink fluids before, 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(e.g. dizzy, nausea, any chest
tightness or discomfort, severe shortness of breath, regular
painful contractions or vaginal bleeding)
Step 4: Be mindful of your mental well-being
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. 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:
#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.
#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.
#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.
#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!
#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:
#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.
#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.
#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.
#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.
#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.
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.
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.
To be in the best possible shape physically and
mentally,
continue to stay on thesame
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
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
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. 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
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
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 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
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
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
Affectionately known as the "baby book" that every
Singaporean child grows up with, the Child Health Booklet (CHB) is provided
to parents at the time of delivery.
Kickstart your child’s Active Start to life! We have a
full suite of resources, sporting activities and ideas for the entire family
to live better through sport.
