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.
CONTRIBUTED BY
Health Promotion Board
What you should know about
GestationalDiabetes
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/m2)
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.
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