In Singapore, all pregnant women will be screened for gestational diabetes mellitus by means of an oral glucose tolerance test, between 24 and 28 weeks of pregnancy.

“The oral glucose tolerance test will be performed earlier in women who have high risk for gestational diabetes mellitus,” says Dr Lim Wei Ying​, Associate Consultant, Department of Endocrinology, Singapore Gener​al Hospital, a member of the SingHealth​ group.

An oral glucose tolerance test would require:

1. Fasting overnight (not eating or drinking anything apart from wate​r)
2. Blood test in the morning, followed by a 75g glucose drink
3. Repeat blood glucose tests at 1 hour and 2 hours after the glucose drink

When you have gestational diabete​s mellitus, you will be under the care of a specialist healthcare team comprising of obstetricians, endocrinologists, specialised nurses, and dietitians.

Gestational diabetes mellitus usually improves with lifestyle measures such as:

1. healthy eating
2. exercise and
3. regular blood glucose monitoring.

Regular self-monitoring of blood glucose level​s will be taught, because it is important to ensure satisfactory glucose control during your pregnancy.

Despite best efforts at lifestyle modifications, some women need to take tablets or insulin injections to control their glucose levels. If insulin therapy is required, the technique for self -insulin injection will be taught.

During antenatal visits, ultrasound scans will be performed to monitor your baby’s growth closely. Regular blood tests will also be performed to monitor your blood glucose control. Individualised advice about timing and type of delivery will also be given to you by the specialist team.

During labour, it is essential for blood glucose levels to be controlled at a satisfactory level. Blood glucose levels will be measured every hour and some women may require an insulin drip for optimal glucose control.

After you deliver your baby, your insulin requirement decreases significantly with rapid improvement of blood glucose levels.

Most patients, who require tablets or insulin injections during pregnancy, would be able to stop their medications. However, some women may have persistent diabetes mellitus after pregnancy.

Therefore, a repeat oral glucose tolerance test is needed for all women with gestational diabetes mellitus, about 6 to 12 weeks after delivery.

Women with gestational diabetes mellitus have:

• a higher chance of having gestational diabetes mellitus in subsequent pregnancies, and also
• a 6-7 times higher chance of developing diabetes mellitus in future.

Lifestyle measures such as maintaining a healthy diet and exercise have been shown to reduce the risk of diabetes mellitus by about 50%.

In addition to lifestyle measures, it is recommended that you:

• ​seek medical attention early for subsequent pregnancies, and
• ​have annual blood glucose tests as surveillance for diabetes mellitus.

Ref: O17