Efforts to begin battle against diabetes in the womb

Singapore has one of the highest incidences of gestational diabetes mellitus (GDM) in the world, with 15 per cent to 25 per cent of pregnancies being complicated by GDM ("War on diabetes needs to start in the womb" by Mr Gerard Wong Choon Hoe; May 11).

As Singapore's leading centre for the management of pregnancies, KK Women's and Children's Hospital (KKH) has led clinical practices and research efforts aimed at detecting and addressing GDM, to lower the risk of diabetes as well as other metabolic diseases in future generations.

KKH and Duke-NUS Medical School recently conducted a study involving expectant women. It demonstrated the benefits of routinely testing for GDM in improving detection and outcomes for women with GDM.

As a result, KKH and Singapore General Hospital (SGH) introduced a six-month pilot trial from January to routinely offer testing for GDM to all expectant women between 24 and 28 weeks of pregnancy.

Over the past four months, the take-up rate for GDM testing has increased steadily from 44 per cent to 77 per cent, with higher detection rates. KKH and SGH will study the findings to better understand the value of routine testing.

KKH has also embarked on a large cohort study (S-Presto) to examine the possible pre-pregnancy influences on long-term outcomes.

GDM carries a lifetime risk of diabetes, exceeding 70 per cent for women. A shift in mindsets of expectant women to be more aware of the importance of pre-natal health and nutrition is important in the war against diabetes.

Women are advised to have good health habits even before pregnancy. Women who are diagnosed with GDM should be educated on the need for regular follow-up with their family doctor, through which, better health outcomes can be made possible.

This would include regular screening and managing their risk factors for diabetes, in conjunction with medical advice from their family doctors. This would apply to all women with GDM, even if the first test post-delivery is initially normal, and regardless of the woman's age.

KKH is embarking upon a programme with our partners to ensure long-term follow-up for women with GDM, to optimise health behaviours and to facilitate routine screening, early detection and management of diabetes.

We are working closely with the Ministry of Health and Health Promotion Board through the Women's Health Committee, in providing the necessary support for women with GDM, to reduce the risk of complications during pregnancy and avoid progression to diabetes.

We hope that together, as an informed community, we can optimise prevention and management of diabetes to win the war on the disease.

Tan Kok Hian (Professor)

Head and Senior Consultant

Perinatal Audit and Epidemiology Unit

Division of Obstetrics and Gynaecology

KK Women's and Children's Hospital

A version of this article appeared in the print edition of The Straits Times on May 21, 2016, with the headline 'Efforts to begin battle against diabetes in the womb'. Print Edition | Subscribe