Diabetes during pregnancy increases the risk of certain health problems like high blood pressure during pregnancy (pre-eclampsia), big baby leading to a difficult delivery and higher chance of needing a cesarean section. Hence, it is important for women with pre-existing diabetes before pregnancy, and those newly diagnosed during pregnancy (i.e. gestational diabetes) to control their blood glucose levels. This will minimise the risk of developing these problems.

There are three steps to manage diabetes during pregnancy, namely, blood glucose monitoring, diet and insulin (if blood glucose levels cannot be controlled by diet alone). Apart from controlling blood glucose levels, the diet should also provide adequate nutrition for the pregnant mother and her baby, resulting in appropriate weight gain similar to that for non-diabetic women.

The diet for diabetes during pregnancy is similar to the healthy diet recommended for all pregnant women, except for the regular distribution and consistent intake of carbohydrate-containing foods (e.g. rice and alternatives, starchy vegetables, fruits and milk) throughout the day.

In other words, you can have three meals and three snacks, with the same amount of carbohydrate-containing foods daily at each meal and snack.

Contrary to popular belief, there is no need for pregnant women to consume glucose or any other sugars for energy, as carbohydrate foods are digested into glucose by the body.

Hence, sugars and sweet foods are not recommended for pregnant women with diabetes, as they are high in carbohydrates, leading to high blood glucose levels, which are often low in nutrients and high in energy, leading to excessive weight gain.

The guidelines for the diet for diabetes during pregnancy can be summarised in the following table. Please see your dietitian for a meal plan specific to your needs.

Reference: HealthHub

Clothes

• Choose loose and sweat-absorbent materials to keep yourself comfortable and clean.
• Wear low heeled and slip-resistant shoes to prevent falls.
• Wear a bra to support and protect the breasts. 

Rest and sleep 

• Sleep at least 8 hours daily, and it would be ideal to have a 30-minutes nap during noontime.
• Pay attention to the physical and mental conditions during the day and take short breaks.
• It is better to sleep sideways toward the final stage of pregnancy. Elevate your feet when resting to help improve blood circulation for the lower limbs and reduce swelling.

Exercise

• Avoid climbing or lifting heavy loads.
• It is safe to attend to most of the household activities but refrain from any work that makes you tried.
• Walking is the best exercise, and you may do some prenatal exercises according to the medical professional's evaluation and guidance.

Sex

• Generally, it is safe to have sex during pregnancy. But if a pregnant mum has a history of going into premature labor or miscarriage, it's better not to have sex during the first three months and the last two months.
• If there is cervical incompetence, a placenta previa, or vaginal bleeding and labor pains before full-term, sex should be prohibited.During sexual activity, if the pregnant woman shows a strong uterine contraction, abnormal bleeding, severe abdominal pain, etc., the couple should stop having sex and go to see a doctor immediately.

Urination and Bowel Movement

• It is better to have a daily bowel movement.
• Do not hold the urine. Go as necessary and do not decrease water intake.
• Eat more vegetables and fruits and drink more water to regulate bowel movement.

Oral Hygiene

• It is recommended that women should receive oral health treatments before pregnancy. Develop good oral hygiene routine during pregnancy, including brushing teeth before bed, Brush your teeth at least twice daily with fluoridated toothpaste, eating less sugary food or snacks, and rinse the mouth often to protect your teeth from any damage. Get regular dental check-ups with your health care at a dental hospital. Use dental floss (toothpick) or interdental brush at least once a day to clean the gaps between teeth. Do not share toothbrushes. Visit a dentist if there is any discomfort.
• Why do pregnant women have a higher incidence of dental decay? Does gum health worsen? Pregnancy causes changes in hormones and eating habits that may cause tooth decay or gum diseases to worsen. Therefore, regular dental health check-ups are very important. It recommends having your routine dental check-ups at dental hospitals every three months during pregnancy (say 12th week, 24th week, and 36th week).

Shower and Bath

• Avoid hot springs during pregnancy.
• Take showers instead of baths, especially during the last two months.
• The volume of vaginal discharge increases, and it will be good to keep the perineum clean and dry.

Environmental and work exposures

Risks from some workplaces might affect the health of developing fetuses. Therefore, pregnant mums should understand how to prevent danger in the workplace. Should there be any potentially hazardous substances and exposures at work, please consult your doctor.

For the women suffering from long-standing essential hypertension (even before pregnancy), anti-hypertensive medications and a low-salt diet are advocated to help treat this condition.

Hypertension that arises only during the course of the pregnancy (gestational hypertension or preeclampsia) is characterised by the development of high blood pressure (>140/90 mmHg), swelling of the extremities and proteins in the urine during pregnancy from >20 weeks of pregnancy onwards. 

Those who are primiparas (never delivered before), above 35 years of age, with twins or triplets or have pre-existing hypertension or diabetes are at a higher risk of developing this condition. In some instances, this condition has been known to arise during labour or after the delivery of the baby. Many other organ systems can also be affected and notably seizures (eclampsia) can occur in severe cases. When the organ systems are severely affected, they can pose a danger to the mother and fetus. 

Treatment entails the delivery of both the baby and the placenta. 

• ​​In mild cases, anti-hypertensives may be prescribed to lower the blood pressure while continuing to follow up the pregnancy closely. The baby's wellbeing will be checked regularly through a variety of tests to ensure that it is growing properly and receiving adequate oxygen. 
   
• In severe cases, admission is necessary and a medication known as Magnesium Sulphate may be administered intra-venously to prevent the mother from developing a seizure or fit. 

The warning symptoms to this severe condition include severe headaches, visual disturbances, severe nausea and vomiting, and right sided upper abdominal pain. If you suffer from any one of these symptoms after being diagnosed with pre-eclampsia, prompt medical attention is mandatory. 

Reference: Healthhub

According to the International Agency for Research on Cancer (IARC) under WHO, cigarette smoking and second-hand smoke are level 1 carcinogens. If you smoke, please quit now.

Women who smoke or inhale second-hand smoke during pregnancy tend to have a high concentration of nicotine or nicotine metabolites such as cotinine residues in their bodies. Growing in the wombs of mothers who smoke will pose negative impacts on the baby's nervous and digestive systems as well as vision developments at various degrees. It increases the risk of miscarriage, birth defect, premature or low birth weight. And these children will be at higher risk of developing leukemia when they grow up.

If the parents are used to smoking indoors or next to their baby, the concentration of nicotine in the baby will be nearly 50 times higher than that of a non-smoker's baby. And even if the parents only smoke at the balcony, the nicotine concentration in their baby is still seven times higher than that of a non-smoking parents' baby.

Smoking or secondhand smoke will not only increase the lead concentration in blood in pregnant women but also pass it through the placenta to the fetus, affecting the fetus's brain development. Nicotine, on the other hand, causes damage to the "neurotransmitter" in the fetus' developing ears, causing hearing problem in children.

Besides, there is a threat of third-handed smoke. The research confirms smoking at home causes high concentration residues of toxic substances in the home, even if it’s a long-extinguished cigarette. These substances will stay in the home in the form of particles that clings on a variety of surfaces (such as furniture like table and chairs, floor, wall, kitchen, bathtub, toilet, etc.). They also can be attached to dust or become volatile toxic compounds that drift into the air after days, weeks, and months. Even if the smoker does not smoke in front of the child, the toxic particles of third-hand smoke will remain for a long time. Hence the person who is in and out of the space exposes to the smoke as well. These substances contain at least 11 highly carcinogenic compounds that cause cognitive impairment in children and increase the risk of asthma, otitis media, and leukemia.

Parents should carefully observe your baby's excretion and record the frequency and characteristics (color/texture). The frequency characteristics not only indicate if the baby is well fed but also indicates if your baby has gastrointestinal discomfort.

There are nine colors in total (color 1 to 6 is abnormal, and color 7 to 9 is normal). If stools are yellow or green color, it is normal. If you notice your baby's stool color is abnormal, please bring your baby to the doctor as soon as possible to get a proper diagnosis of his/her health condition.

The number of times your newborn has bowel movements is not necessary the same every day. It varies by the individual physique, rate of digestion, and the amount of milk that baby drinks. As breastmilk is very easily digest by baby, a breastfed baby will usually have three to eight times of bowel movements a day. It is more frequent than a formula-fed baby. However, when your baby is about one month old, there will be a period of time that the number of the bowel movements of a breastfed baby reduces significantly, it is possible to have a reduction of bowel movement to only once in a few days. If the stool color is normal, texture is soft, no vomiting or bloated stomach issues, etc., and he or she is active and drinks breastmilk as per normal, you should not worry so much.

If your baby's stool texture hardens, turns solid, the number of bowel movements reduce, or even no bowel movements for a few days, gently massage your baby's abdomen clockwise to sooth your baby's digestive system . Alternatively, lift your baby's legs up, insert a thermometer (coated with lubricant such as Vaseline or glycerin) into your baby's anus 1 to 2 cm, rotate gently to stimulate your baby's digestive system to help bowel movements. Consult your healthcare professional if this does not work.

If there are some white particles in your baby's stool, it is mostly because your young baby's digestive system is still developing, results in some substances in the milk that cannot be absorbed and discharged. This will usually improve after six months.

Every baby's stools smell different. After you start weaning your baby, the stools will smell like the food he or she has taken. The smell of his or her stools will be different from babies who are fed on a full-milk diet period. If your the baby’s stools smell significantly different from usual, especially stools with a foul odour, you need to pay extra attention to his or her stool patterns and check if there are any other conditions. Do seek medical attention when necessary.

Make an appointment with your doctor as soon as you know you're pregnant. Antenatal care is important to keep you and your baby healthy throughout the pregnancy. You'll likely see your doctor for the first time in week 5. Most people will have about 10 appointments before baby is due.

Ideally you should visit your doctor with your partner and go armed with both your medical histories. Your doctor will be interested to know about any family medical history that may have an impact on your pregnancy. These include genetic conditions or diseases like diabetes. If you've had previous pregnancies, miscarriages or problems with fertility, your doctor will need to know about these too.

Here is a complete guide of week 1 to 40 of your pregnancy week by week.

There are a series of prenatal tests and scans available to check on the well-being of both mother and baby during pregnancy but not all tests are necessary. Your doctor will be able to advise you on the ones you need.

Apart from the routine tests that are carried out at every antenatal visit such as blood pressure, weight, and urine dipstick for sugar and protein, the following tests are also performed if your doctor considers them necessary.

Reference: HealthHub, HealthXchange, KK Women's and Children's Hospital, Mount Elizabeth Hospitals

What is Down Syndrome? 

Down Syndrome is the most common cause of significant mental retardation and learning disability in children.

It is caused by a change in chromosomal number (genetic makeup) in the egg before it is fertilised by the sperm (at the time of conception). This usually occurs due to chance, and is more common in older mothers.

As a result, the fertilised embryo contains an extra chromosome 21 making it three instead of the usual pair (hence the name trisomy 21).

It is important to know that people with Down Syndrome can also have reasonably long and fulfilling lives.

Throughout the world, the frequency of Down Syndrome is about one per 700 births.

The risk of having a baby with Down Syndrome increases as the mother’s age increases. 
 

A result of one in 300 means that 299 out of 300 women with this particular test result will not have an affected baby, and only one will. As you can see, it is not a test for the presence of a Down Syndrome baby, but a way of comparing your chance of having one. So, a 40-year-old woman would be very reassured by a result of one in 800 and a 20-year-old woman may opt for amniocentesis if her result was one in 100 (Figure 11.3). 

​Overall, about six to seven out of 10 Down Syndrome babies will be detected by the serum screening. However, there will still be some that are undetected and will be born to mothers who have had a “low-risk” result. 

​These screening tests do not guarantee that the baby will be healthy. It only helps to screen for Down Syndrome. If the test result is “low risk”, this means that the chance of having this condition is reduced.​
 

Diagnostic Tests (Amniocentesis or Chorionic Villus Sampling)

These are tests that obtain cell samples from the baby and can tell you for sure if the baby is affected with Down Syndrome. It is only performed for high-risk cases detected on screening due to the inherent risks of miscarriage associated with these procedures.

The purpose of diagnosing this condition is to allow the couple the various options of whether to continue with the pregnancy or have an abortion.

Amniocentesis — Down syndrome can be diagnosed early in pregnancy from 15 to 20 weeks of pregnancy by amniocentesis. This involves a very fine needle being passed into the womb, under ultrasound guidance, and sampling of the amniotic fluid (water bag) around the baby. It takes about 2–3 weeks for the results to be ready although rapid tests (PCR) can also be done within 3–5 days. Most women do not find it too uncomfortable and takes about 5–10 minutes as an outpatient procedure. There is a risk of 0.5 percent of a spontaneous miscarriage after the procedure, which usually happens within two weeks after the procedure.

Chorionic villus sampling (CVS) — Chorionic villus sampling is another option that is performed even earlier at about 12 weeks of pregnancy. Like amniocentesis, it is also done under ultrasound guidance. A needle is inserted into the placenta to withdraw the cells through the abdomen or cervix. It allows earlier diagnosis and therefore reduces the anxiety of waiting. The risk of a miscarriage is similar to that of an amniocentesis.

Fetal blood sampling (FBS) — This is a test that involves the sampling of fetal blood from the umbilical cord. The risk of miscarriage is much higher at two to three percent and thus, FBS is rarely performed for the diagnosis of Down Syndrome. ​
 

Important

After the amniocentesis or CVS, it is important to return to the hospital immediately if you run a fever, experience any unusual lower abdominal pain, vaginal bleeding or leakage of fluid from the vagina.

Reference: HealthHub

During pregnancy, your baby depends on you as his main source of nutrition. Maintaining a healthy diet during pregnancy will help meet the developmental needs of your baby, maintain your health as well as prepare you for breastfeeding. It can even be said that your nutritional status at the time of conception, in addition to your diet during pregnancy, will affect the h​ealth of your grandchildren and future generations.

Recent studies show that chronic conditions such as coronary heart disease, hypertension, type 2 diabetes and obesity, and perhaps osteoporosis, and breast and ovarian cancers, have their origins in the womb. This makes it all the more important for you to eat healthily before, as well as, during pregnancy.

How to have a balanced diet during pregnancy

As a guide, the average energy requirement of a non-pregnant Singapore woman is 1700 kcal per day. During pregnancy, your energy requirement increases by 370 kcal per day in the 2nd trimester and 480 kcal per day in the 3rd trimester.

However, maintaining a balanced diet during pregnancy shouldn't be reduced to counting calories.

Here's a tabular guide on achieving a balanced diet during pregnancy. All you need to do is to ensure that all the food groups are included in your diet, based on the recommended servings. 

1. rice bowl
2. 250ml cup
3. 10 inch plate

Pregnant women are prone to constipation caused by hormones that relax the gastrointestinal muscles, taking iron supplements, and abdominal fetus compression. It is recommended to consume more whole grains, plenty of fruits and vegetables for dietary fibers to help prevent constipation.

If you have nausea and vomiting in early pregnancy, you should eat a small number of meals and choose low-fat and non-irritating foods. When you wake up in the morning, you can eat grains such as cookies and steamed buns to improve morning sickness. At the end of pregnancy, avoid excessive carbohydrates and fat intake, which will increase body fat.

Reference: HealthXchange

During pregnancy, your body requires more than 30 different nutrients. "Seven nutrients, namely vitamin A, vitamin C, folic acid, iron, calcium, vitamin D and DHA (docosahexaenoic acid) are especially important as they help with your baby's development as well as maintain your health

Their recommended dietary allowances (RDA) per day, functions and food sources are detailed in the table below.

Reference: HealthXchange

Food safety is extremely important during pregnancy. This is because bacterial toxins and certain harmful chemicals such as alcohol and methylmercury can pass from mother to baby, and cause undesirable outcomes.

Avoid:
Unpasteurised milk;

Soft cheeses, e.g. brie, feta, camembert and roquefort;

Liver pates;

Uncooked hot dogs, ham and luncheon meats

These foods are prone to Listeria monocytogenes, a bacteria that causes listeriosis, which may result in miscarriages and stillbirth.

Avoid:

Raw or undercooked meat,

Poultry,

Seafood, e.g. raw oyster, cockles, sashimi and sushi;

Raw or half-boiled eggs

Raw and undercooked animal foods contain a variety of food-borne bacteria and viruses. Changes in your metabolism and circulation during pregnancy may increase the risk of bacterial food poisoning, and your reaction may be more severe than if you were not pregnant.

Avoid:
Swordfish,

Shark,

Tilefish,

King mackerel

Limit:

Canned albacore tuna

Herbal Supplements

Herbal products have not been studied enough to be recommended during pregnancy. Do consult your doctor if you are planning to take these herbs.

Chinese medicine of unknown origin should not be consumed without approval from a qualified TCM practitioner for medicinal use and usage.

Alcohol

Mothers who drink alcohol have a higher risk of miscarriages and stillbirth, and excessive alcohol consumption may result in fetal alcohol syndrome, including facial deformities, low birth weight and mental retardation.

Unwashed Salad and Raw Vegetables Sprouts, including Alfalfa, Clover, Radish, and Mung Beans

Unwashed salads may be contaminated with bacteria from the soil, while raw vegetable sprouts contain high levels of germs, which can be harmful to health.

Reference: HealthHub