Better Care and Support for Mothers With Gestational Diabetes
Better Care and Support for Mothers With Gestational Diabetes
The pilot Temasek Foundation Gestational Diabetes Mellitus Care Programme allows the condition to be detected earlier in expectant mothers, who have seen positive outcomes with timely intervention and close follow-up care.
Without a family history of diabetes and a mere weight gain of six kilograms throughout her pregnancy, it came as a surprise to Miss Jacey Yeh, an arts administrator, when she was diagnosed with gestational diabetes. Photo: Temasek
For up to seven times a day, Ms Jacey Yeh had to prick herself to check her blood sugar levels. She also had to resist her cravings and the temptations of sweet treats, as she had to stick to a strict diet.
Although it was her first pregnancy, she did not experience the usual symptoms of morning sickness, and fatigue. She also only gained 6kg throughout the pregnancy so it came as a surprise when she was diagnosed with gestational diabetes mellitus (GDM). Her family has no history of diabetes either.
“My biggest concern was the impact of the condition on my baby’s health,” recalled the 40-year-old arts administrator, who went on to give birth to a healthy baby girl in June 2018. “I tried to avoid sugar as much as possible and changed to multigrain bread and brown rice. But it was quite hard as food options are limited when eating out and it was hard for me to resist my favourite desserts like cakes.”
In Singapore, up to one in five women has GDM, a condition that affects pregnant women without existing diabetes due to high blood sugar levels. Ms Yeh was alerted to her condition during regular screenings at KK Women’s and Children’s Hospital (KKH).
Help arrived in the form of the Temasek Foundation Gestational Diabetes Mellitus (TF GDM) Care Programme. The pilot scheme, which ran from October 2016 to September 2019, was a collaboration between KKH and Temasek Foundation to improve detection, care and support for women with GDM and their families.
Almost 5,000 pregnant women with GDM and their families benefited from the programme.
GDM may impact the health of your child. And as mothers, we all want the best for our child. It might also impact our health if the condition is not managed properly.
Miss Jacey Yeh, Arts Administrator
Long Road to Recovery
Today, more than a year after giving birth, Ms Yeh’s blood sugar levels are still slightly above the norm. However, with the programme’s support, she is able to manage her condition well without the use of medications.
Following her successful delivery, she continued to go for blood sugar level checks as her doctor had warned that the condition could develop into Type 2 diabetes. Although GDM resolves itself in most women after pregnancy, there is a lifetime risk of up to 70 per cent that they would develop Type 2 diabetes post-delivery.
Type 2 diabetes is the most common form of diabetes, which causes the blood sugar level to become too high. Affected people are at risk of eye, nerve and kidney damage, among other complications.
The TF GDM Care Programme offers early GDM screening to all women in their 24th to 28th week of pregnancy. If GDM is detected, they will be monitored closely by Diabetes Care Navigators – specially-trained nurses who provide prenatal and postnatal education on nutrition, exercise and management of sugar levels at the ward before the mother is discharged.
Diabetes Care Navigators also refer all patients to a polyclinic of their choice and follow up with the polyclinic to track their visits and ensure continuity of care.
“As an academic medical centre that specialises in the healthcare needs of women and children, we are very interested in the topic of GDM as it is a common yet manageable condition,” said Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, Division of Obstetrics and Gynaecology at KKH.
At KKH, Ms Yeh learnt how to plan her diet and use a glucose tracker. She also got to sample a day of carefully planned meals that met her health needs.
In her third trimester, she was recommended to “walk for 15 minutes after food” but found it challenging as the position of her baby was putting pressure on a nerve, causing her legs to go numb. However, she pressed on for the sake of her child.
There is more that needs to be done, particularly in terms of education and awareness of the (GDM) condition.
Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital
Proper Care Cuts Risks
Women with GDM typically do not display any symptoms as increased blood sugar levels are detected only during screening tests. However, some women may experience increased thirst, urination, appetite and fatigue.
If overlooked, GDM could pose serious risks to both mother and child. These include premature delivery and urinary tract infection for the mother and excessive birth weight or even sudden foetal death for the baby.
The good news is the TF GDM Care Programme gathered enough research in antenatal and postnatal care to reduce the lifetime risk of diabetes in women with GDM.
The proportion of women who were screened for GDM at KKH grew from 65 per cent before the programme to 86 per cent after its launch. The number of poor birth outcomes such as stillbirth and macrosomia – babies who have excessive weight upon birth – was also cut by half.
However, not all mothers with GDM want to be part of the programme, said Prof Tan. Some decline any form of support while others prefer to continue their care elsewhere.
“Although the programme has shown very positive results, there is more that needs to be done, particularly in terms of education and awareness of the condition,” he noted. “We hope to adopt this model as a new enhanced approach for the management of GDM in Singapore.”
For mothers like Ms Yeh, the programme has offered invaluable support and information. She has since resumed her regular exercise routines and cut down on her sugar intake.
Offering hope to other mothers with GDM, she said: “It’s not the end of the world and you are definitely not alone.”
Temasek Foundation GDM Care Programme has helped close to 5,000 mothers over the last three years. Photo: Temasek
