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Half of women who get diabetes when they are pregnant go on to develop the condition for life.
 When Ms Camilia C. was pregnant with her second child last year, she had an added worry – keeping her blood sugar level low. Into her fourth month of pregnancy, she was diagnosed with gestational diabetes mellitus (GDM), a condition that doctors say plagues close to 10 per cent of all pregnant women here. The 37-year-old housewife recalled: “I would take soft drinks every morning during my first three months and eat whenever I wanted to. Sometimes, I even skipped breakfast.” Ms C. was told by her doctor that GDM is not a permanent condition for most women.
Dr Abel Soh, associate consultant at the Department of Endocrinology at Singapore General Hospital (SGH) said that approximately 90 per cent of women with GDM have their blood sugar levels return to normal soon after delivery, though 30 to 60 per cent of these women will have GDM again in their subsequent pregnancies. Unfortunately for Ms C., her blood sugar level remained high three months after childbirth and she was diagnosed with type 2 diabetes. She said: “I cried for days after that and was depressed for a while.” Dr Soh said that her case is not unusual as about 10 per cent of these women can go on to develop either pre-diabetes or type 2 diabetes after delivery.
Common risk factors
Dr Wee Horng Yen, senior consultant and director of the Women Wellness Centre at KK Women’s and Children’s Hospital, noted that women like Ms C. with GDM during pregnancy share many common risk factors with other diabetics. She is overweight with a body mass index that hovered between 25 and 30 during and after her pregnancy, was pregnant at a relatively older age and has a family history of diabetes. What Ms C. was not aware of was that a woman’s body worked differently during pregnancy.
Dr Kevin Tan, vice-president of the Diabetic Society of Singapore, explained: “As pregnancy progresses, placental hormones which help sustain the pregnancy and the developing baby interfere with insulin’s action in lowering blood sugar.” This insulin resistance results in glucose not leaving the blood to be changed to energy, hence building up to high levels in the blood, added Dr Goh Su-Yen, a consultant from the Department of Endocrinology at SGH, who is also the director of its diabetes centre.
Insulin injections during pregnancy
GDM is defined as any degree of high levels of glucose in the blood with onset or first recognition during pregnancy. It includes cases of undiagnosed diabetes before conception, which were picked up through screening during pregnancy. Dr Wee said that the definition does not take into account the persistence of the condition after pregnancy.
While Ms C. had to use insulin injections to manage her condition during her pregnancy, other pregnant women could do with just diet modifications and exercise. For Ms Lim Hoy Wan, a 40-year-old restaurant supervisor, she had to test her blood sugar level diligently after each meal. She said in Mandarin: “If it moved towards the high end, I would take care to eat less during the next meal.” Her GDM lasted only for the duration of her pregnancy and she gave birth to her first child, a daughter, in 2008.
Dr Wee explained that being pregnant increases the risk of getting diabetes for a person who already has the risk factors for the condition. He puts the percentage of those who do go on to develop the chronic condition – whether immediately after the birth of their baby or later in life – at 50 per cent of all the women with GDM. He said: “It’s important for a woman who has had GDM to continue to exercise and have a healthy diet after pregnancy to prevent or delay getting type 2 diabetes. She should also remind her doctor to check her blood sugar every one to three years.”
Ref: V10 |
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