Prof Tan Kok Hian (right), Dr Han Wee Meng, Head and Senior Principal Dietitian, Nutrition and Dietetics Department, KKH (left) and Diabetes Care Navigator Asmira Mohamed Rahim, Nurse Clinician, Obstetrics Day Assessment Centre, KKH (middle), are part of the multidisciplinary team supporting patients with gestational diabetes mellitus at KKH.
gestational diabetes mellitus (GDM) programme run by KK Women’s and Children’s Hospital (KKH) has benefited 4,864 women and significantly reduced poor birth outcomes associated with poor GDM management, such as stillbirth and macrosomia (giving birth to large babies), by 50 per cent.
In Singapore, up to one in five women is at risk of developing GDM during pregnancy. Women with uncontrolled GDM have a higher risk of developing complications during pregnancy. The condition also has long term negative impacts on mother and child health, such as an increased risk of obesity and Type 2 diabetes mellitus.
“To prevent or delay the onset of diabetes, our primary goal is to create a seamless platform where women with GDM can continue to be provided care from the hospital to the community, and to receive early intervention for at least three years,” shares
Professor Tan Kok Hian, programme lead and Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, Department of Maternal Fetal Medicine, KKH.
Funded by Temasek Foundation, the Temasek Foundation GDM Care pilot programme offers screening to pregnant patients at KKH between 24 and 28 weeks of gestation, facilitating early detection, intervention and education for those diagnosed with GDM. Women who are diagnosed with GDM are encouraged to enrol in an educational course led by KKH Diabetes Nurse Navigators to learn about the disease, and how to make lifestyle changes to control their blood sugar and monitor their blood glucose levels.
Since the programme was implemented in 2016, 86 per cent of pregnant women managed by KKH underwent early screening for GDM, in comparison to 65 per cent prior to the programme. There was a 50 per cent reduction in poor birth outcomes for mothers with GDM, and a 39 per cent increase in women continuing on to complete their six-week postnatal GDM screening in comparison to 20 per cent prior to the programme.
Developing a new model of care beyond pregnancy
Women with GDM are at risk of developing diabetes at some point in their lifetime following delivery. Hence, under the programme, women are offered a routine check-up at a polyclinic of their choice six weeks after delivery. Those whose GDM have resolved are offered an annual follow-up at the polyclinic for the next three years; those with GDM who consequently develop Type 2 diabetes mellitus will receive their follow-up at the polyclinic for optimal management of the condition.
An innovative ‘I-Poly’ system was also developed to facilitate a smooth transition for mothers to be cared for in their community, after delivery. The system allows Diabetes Care Navigators to help with arranging follow-up appointments and coordinate with polyclinics to encourage attendance. If a woman misses an appointment, the Diabetes Nurse Navigator is able to contact and remind her to visit the polyclinic.
“Early detection, timely intervention and close follow-up care are absolutely crucial for the optimal management of women with GDM,” shares Prof Tan. “Through structured care and education, we continue to gain ground in strengthening the prevention and management of diabetes and associated health risks for future generations.”
Research trial into continuous monitoring for metabolic health
To enhance care and management compliance for women with GDM, the programme is also pioneering research into the use of a wearable monitoring system to track the glucose profiles of women throughout their pregnancy.
In collaboration with the IPRAMHO (Integrated Platform for Research in Advancing Metabolic Health Outcomes in Women and Children) network, which was launched by KKH in 2017 to advance translational research in metabolic health, a research trial is ongoing to investigate the applicability, acceptability, compliance and validity of such a monitoring system in women with normal pregnancies and pregnant women with GDM.
Professor Tan Kok Hian conferred SingHealth Duke-NUS Benjamin Henry Sheares Professorship in Obstetrics and Gynaecology
In addition to being a recipient of the Benjamin Henry Sheares Gold Medal Memorial Lectureship Award, Professor Tan Kok Hian is the inaugural recipient of the SingHealth Duke-NUS Benjamin Henry Sheares Professorship in Obstetrics and Gynaecology – a professorship established with donations from the Sheares family and other donors in honour of the late Dr Benjamin Henry Sheares, Singapore’s father of modern obstetrics and gynaecologist, who later served as the second President of the Republic of Singapore.
“An active researcher and a world pioneer in the use of extracellular vesicles as biomarkers for preeclampsia – an area of research interest he shares with the late Dr Sheares – Prof Tan is an international expert in preeclampsia management,” said Professor Ivy Ng, Group Chief Executive Officer, SingHealth, and Professor Thomas Coffman, Dean, Duke-NUS Medical School.
“His work in active translation of research findings, such as initiating universal gestational diabetes mellitus (GDM) screening and leading the development of guidelines for key clinical aspects on O&G both locally and in the region, have made significant clinical impact. We have every confidence that the conferment of this Professorship will be a catalyst in the advancement of O&G care for mothers in Singapore and beyond.”