War on diabetes needs to start in the womb

Singapore's war on diabetes should also take into consideration pregnant women ("MOH to wage war on diabetes"; April 14).

Diabetes in pregnancy, also known as gestational diabetes mellitus (GDM), is a condition of abnormal or elevated glucose readings which occur during pregnancy.

Previously, only pregnant women with high-risk factors - such as a high body mass index, being aged 35 or above, or having close relatives with diabetes - were targeted for screening.

But a study published by KK Women's and Children's Hospital (KKH) and Duke-NUS Graduate Medical School has revealed that this approach of targeted screening failed to identify more than 60 per cent of mothers with mild diabetes ("Diabetes screening for expectant mums"; Nov 18, 2015).

KKH and the Singapore General Hospital are now offering GDM screening to all expectant women at 24 to 28 weeks of pregnancy, as part of a six-month pilot trial that kicked off in January.

In Australia, such screening is mandatory for all pregnant women. Women with high-risk factors are sometimes screened much earlier.

Women with GDM are at higher risk of developing diabetes later in life. There is also emerging and compelling evidence of a high prevalence of Type 2 diabetes in the adult offspring of mothers with GDM.

We are learning that the environment in the womb plays an important role in the development of diabetes.

Only with screening, dietary or medical management, and producing a normal womb environment, may we hope to reduce the risk of diabetes for future generations.

As GDM screening is only just starting to take off in Singapore, more concerted effort needs to be placed on developing a set of management guidelines and providing more subsidies for glucose-testing meters.

Gerard Wong Choon Hoe

A version of this article appeared in the print edition of The Straits Times on May 11, 2016, with the headline 'War on diabetes needs to start in the womb'. Print Edition | Subscribe