Gestational Diabetes Mellitus (GDM)

What happens after delivery if I have GDM?

GDM usually resolves after delivery. In most cases, if you have to take medications to control GDM during your pregnancy, you do not need to continue taking them after your delivery.

At routine follow-up in the clinic six weeks after delivery, a repeat OGTT will be performed for you. This is to ensure that the GDM has resolved.

If the OGTT is still abnormal at this time, you will either be referred to a doctor who specialises in diabetes or to the polyclinic for follow-up, depending on the severity of the results.

Even if the OGTT is normal, you are encouraged to go for diabetes screening every year as there is still a one in three chance of developing diabetes at a later stage if you have had GDM during your pregnancy.

Why is it important to follow up after delivery?

Although most women with GDM recover after the pregnancy, these women still have a much higher risk of developing diabetes in future. If GDM is not detected early or well-controlled, diabetes can lead to serious and permanent complications such as kidney failure, blindness and lower limb amputation. Following up with your doctor after delivery can help in early detection of diabetes, allowing timely intervention and treatment, so that these risks can be reduced.

How can I reduce my risk of developing diabetes in future?

Sensible eating and regular exercise, both of which contribute to reducing body weight and therefore body mass index (BMI), can help reduce the risk of diabetes in future.

A high BMI is associated with a higher risk of developing diabetes.

Weight loss should be slow, steady and sustained. A reduction of 5 to 7% of body weight in six months is a safe and effective weight loss goal.

What are some recommendations regarding diet and exercise?

Dietary recommendations

‘My Healthy Plate’ (Health Promotion Board, Singapore) can be used to guide eating patterns. This is a friendly visual tool on healthy eating habits designed for Singaporeans by the Health Promotion Board (HPB).

• Choose carbohydrates with a low glycaemic index (e.g., wholegrain products, brown rice, wholemeal bread, oats, chapatti, pasta and noodles, biscuits and cereals). These are also rich in vitamins and important trace elements and contain fibre which slows digestion.
• Fill half the plate with green vegetables.
• Aim for five servings of fruit and vegetables per day (three servings of vegetables and two servings of fruit).
• Limit the amount of processed food. Choose fish and beans instead of red and processed meats as sources of protein. Oily fishes contain omega-3 fatty acids which are good for the brain and heart. Aim for two portions of fish per week.
• Reduce intake of sweetened drinks and food such as biscuits and cakes. Water is best but unsweetened tea and coffee can be taken in moderation. If you have canned drinks, go for diet or ‘zero’ options.
• Use healthier oils (e.g., canola, olive and peanut) which contain monounsaturated fats, and reduce consumption of fried food and cakes as these contain trans fats which are unhealthy.

Exercise recommendations

Regular exercise helps to burn calories, thus helping you to achieve weight loss. Aim for at least 150 minutes of physical activity at least three times a week, if there are no medical restrictions. If you are used to a sedentary lifestyle, build your exercise level up slowly by approximately 30 minutes a week over five weeks.

Note: Your normal moving about over the course of a day does not count as exercise.

Suggestions:

• Taking a 20-minute walk after dinner
• Using the stairs instead of the lift
• Getting off the bus one stop earlier and walking the rest of the way to your destination
• Going swimming

The GDM patient journey

​Other resources

Below are some materials for your reference and use in managing gestational diabetes:

• Instructions for Blood Sugar Monitoring
• Pictorial Guide on Glucometer Usage
• Outpatient Diabetic Monitoring Chart