Meera had always dreamt of being a mum ever since she was a teenager. As it had been two years since she got married, she and her husband thought it would be the right time to try for a baby.
She bought some folic acid supplements from the pharmacy as she had heard that taking this before pregnancy could reduce the risk of birth defects in the baby.
She wondered if she should be doing or eating anything else to prepare herself for pregnancy and to give her baby the best start in life.
Many of her cousins and friends already had children, and a few of them had developed gestational diabetes during their pregnancies. This is a high blood-sugar condition that is first diagnosed during pregnancy.
She found out that Singapore has one of the highest gestational diabetes rates in the world, affecting about one in five pregnancies.
Women of Asian ethnicity seem to be particularly vulnerable.
The condition is associated with an increased risk of complications such as large babies, birth trauma, caesarean section delivery, high blood pressure in pregnancy, jaundice in babies and admission to the neo-natal unit.
Often, the woman's blood-sugar level returns to normal after delivery but she is still seven times more likely to develop Type 2 diabetes in future.
Babies born to mothers with higher sugar levels are also more likely to develop obesity, diabetes and heart disease later in life.
This information made Meera worried because she suspected she was at risk of gestational diabetes. Her mother has diabetes and Meera herself was slightly overweight and already 36 years old.
If her friend, Mei, who was very slim, could develop gestational diabetes, she knew it could happen to her too.
It then occurred to her that she could already have diabetes and not know it.
Fortunately, Mei heard about a study which may be applicable to Meera when she went for her postnatal check at the gynaecology clinic at the National University Hospital (NUH).
She picked up a brochure for Meera. The study hopes to examine the benefits of taking a specially formulated nutritional drink designed to determine if healthy sugar levels can be maintained in a mother to promote the health of her baby.
When Meera called the study hotline, she was excited by the way the research coordinator explained the study.
She was reassured that the nutritional drink, which is a supplement, had been approved by the Health Sciences Authority.
She decided to join the study and went for her first study visit. Her pregnancy test was negative, which meant she could still participate in the study.
During the visit, she had an oral glucose-tolerance test to check that she was not already diabetic, plus a few other blood tests.
She had to answer some questions about her diet, exercise and lifestyle, and have her weight and body measurements taken.
This made her feel slightly guilty and she decided she had to do something about her weight and exercise more.
She knew this was good for her own health and also for her future baby's health.
Just as with gestational diabetes, being overweight at the start of pregnancy can lead to similar pregnancy complications and increase the baby's chances of developing obesity and diabetes.
The study's supplement comes in sachets. Each sachet is mixed in a small glass of water and drunk twice a day, starting before conception and continued until the end of pregnancy.
Meera liked the slight orange flavour and thought she could easily continue taking the supplement.
The study will compare this special nutritional formulation with a standard formulation.
She would not know which supplement she would be on. But she did not mind as they both contained common micronutrients such as folic acid, iron and calcium that she needed for a healthy pregnancy.
One has a few more micronutrients and ingredients such as probiotics. These friendly bacteria could help maintain healthy blood sugar metabolism and maybe even prevent a woman from getting gestational diabetes.
Meera was happy to find out that her glucose test result was normal at a follow-up study visit a few weeks later.
Now she really felt ready for a baby and could not wait to get pregnant. She was also pleased that she could make a contribution to medical science by taking part in the study.
It would be really amazing if we find out at the end of the study that a simple nutritional supplement could prevent gestational diabetes and improve the health of our children.
- Associate Professor Chan Shiao-Yng graduated with a medical degree from the University of Cambridge in 1995 and completed her specialist training in obstetrics and gynaecology in the United Kingdom. She is a consultant obstetrician at the National University Hospital, with a special interest in the management of pregnant women with medical disorders.
