Don't take it lightly. Gestational diabetes is not just a pregnancy problem

Women are failing to return for diabetes check-ups after delivery, putting their health and that of their children at risk. We can do more to help them.

Published on 10 December 2025 | Source: The Straits Times © SPH Media Limited. Permission is required for reproduction.

By Dr Lisa Ooi, Assistant Chief Executive at Biomedical Research Council, A*STAR.

Gestational diabetes poses risks to pregnant women as well as their children.
PHOTO: ST FILE

I was diagnosed with gestational diabetes mellitus (GDM) in my second pregnancy, and again in my third. This came as a surprise because I didn’t have it in my first.

Determined to keep my glucose in check, I began seven times a day finger-prick tests before and after meals and paid close attention to my diet.

The careful monitoring worked. I was able to keep my blood sugar within range and carry my baby safely to term, but I still felt the weight of what it meant for me and my baby.

GDM occurs when hormones of pregnancy make it harder for the body to use and produce insulin, causing blood sugar to rise. Many people may not realise that it is not just a condition of pregnancy.

It is a signal of risk for both mother and child, like a car’s warning sensor that lights up before the engine fails, giving you time to act. Ignoring it can bring lasting health problems, from type 2 diabetes and obesity to complications affecting vision and kidney function.

Since the introduction of universal screening for GDM in 2018, Singapore has made important strides in detecting it early, even among women previously considered to be at low risk. But, as my experience shows, the real challenge is what comes next.

Only half the women with GDM return for a diabetes screening in the first year after delivery. The number falls sharply after that.

This postnatal drop-off is the blind spot we urgently need to close.

Slipping through the cracks

During pregnancy, women monitor their diet carefully, test their glucose regularly, and receive clear guidance from their obstetric teams. But once the baby arrives, the mother becomes caregiver first, and her own long-term health often gets pushed aside.

As women move from obstetric to primary care, it becomes easy for long-term monitoring to slip through the cracks.

I experienced this shift myself when I developed GDM in my second and third pregnancies. While the care I received during pregnancy was comprehensive, the reminders, structure and follow-up after delivery were far less visible.

In addition, many women assume GDM disappears once the baby is born. It is also more common than many realise, affecting about one in five pregnancies in Singapore. The higher rates here reflect increasingly common risk factors, older maternal age, higher pre-pregnancy weight and an underlying Asian predisposition to diabetes.

Yet, women who develop GDM during pregnancy have a twelve-fold higher risk of developing type 2 diabetes four to six years after delivery compared with women who do not have GDM.

The risk extends to their children. Higher maternal glucose levels during pregnancy, even within the normal range, have been linked to more body fat in newborns, in long-term birth cohort studies such as GUSTO (Growing Up in Singapore Towards healthy Outcomes).

Particularly in girls, this persists into the preschool years - an early marker of future obesity and metabolic risk. Other GUSTO studies also show that children born to mothers with GDM display subtle differences in brain activity linked to attention and learning.

The low perception of risk amongst mothers mirrors a broader pattern of low awareness. The 2024 Diabetes Perception Report (IPUR–NUS) found that nearly 70 per cent of people with prediabetes did not know they had it, and fewer than half of those with diabetes were aware of their condition.

Diabetes is more dangerous for women

Large population-based cohort studies show that women with type 2 diabetes have 25-50 per cent higher cardiovascular risk than men with the same condition. This refers to the additional risk of heart attack, stroke, or cardiovascular death, observed in women after adjusting for age and other common factors.

In Singapore, a recent study found that women under 65 with diabetes and impaired kidney function had higher mortality risk than their male counterparts.

Given these heightened risks, how do we improve postpartum support for women diagnosed with GDM?

Encouraging signs of progress

Singapore’s health authorities now recommend a glucose test within six to 12 weeks after delivery, and regular lifelong screening.

And the National University Hospital (NUH) recently launched a gestational diabetes service which helps women transition more smoothly from maternity care to primary care. It provides postpartum screening reminders, structured lifestyle support and clear education on long-term risks - the kind of practical, timely guidance that can make a real difference.

My own experience with GDM has shown me how easy it is to de-prioritise health checks after the baby arrives. But it has also shown me how powerful early awareness can be. GDM gives us a window into a woman’s future health, long before symptoms appear, and that is an opportunity we should not waste.

Most women are not avoiding care; they are doing their best while rising to the challenge of providing care for a newborn. However, we can do more to help them understand the risks to their health and equip them with simple, practical tools that can make a real difference.

A key step is for the mothers to proactively raise their GDM history at postnatal visits and request a scheduled follow-up. This ensures that recommended glucose checks are not missed, and that the move from obstetric to primary care does not dilute awareness of their higher long-term risk.

Women can also use simple, low-cost tools at home to stay aware of changes in their own risk. Tracking weight or waist-to-hip ratio, for instance, can help them spot creeping weight gain or fat distribution, both strong predictors of future diabetes and heart disease.

Staying physically active is especially important, not just for weight, but for maintaining muscle health, which declines through midlife and can worsen glucose control. Even simple resistance exercises can help preserve muscle and improve long-term metabolic health.

These actions may seem small, but they can change the diabetic trajectory for years to come.

Families and the wider community - including workplaces - also have a role to play. When spouses, caregivers, employers and healthcare teams understand the long-term implications of GDM, they can support women in building healthier routines and making time for their own wellbeing, not just everyone else’s.

If we treat GDM as the early warning it truly is, and if we support women beyond childbirth with consistent follow-up and practical, sustainable habits, we can reshape the health outcomes of mothers and their children.