Opening Address By Dr Amy Khor, Senior Minister of State, Ministry of Environment and Water Resources and Ministry of Health, At the Asia Pacific Diabetes In Pregnancy Conference & Ipramho Iniernational Meeting, 10 January 2020

Professor Alex Sia, CEO, KK Women’s and Children’s Hospital

Professor Tan Kok Hian, Chairman, Organising Committee of the Asia Pacific Diabetes in Pregnancy Conference & Lead for IPRAMHO (read as eye-pram-ho)

Professor Victor Samuel Rajadurai, President of Perinatal Society of Singapore

Distinguished guests

Ladies and gentlemen

        A very good afternoon to you. Indeed, I am pleased to be back here at the Asia Pacific Diabetes in Pregnancy Conference & Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children (IPRAMHO) International Meeting. I am indeed pleased to see this meeting growing from a regional conference to an international one, and I was telling Prof Alex that I am very pleased that you have continued to invite me to this conference. It allows me to complete the picture – from optimal management, to optimal nutrition, and now optimal exercise.

Burden of gestational diabetes

1.    Gestational diabetes (GDM) is on the rise globally due to increasing childbearing age as well as pre-existing diabetes and obesity in pregnancy. The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) cohort study reported a high incidence rate of one in five Singaporean pregnant women developing GDM. If not detected or well managed, GDM will lead to adverse consequences such as caesarean section, foetal macrosomia, stillbirth, and risk of developing type 2 diabetes later in life for both mother and child. Padmapriya V, et al. Associations of Physical Activity and Sedentary Behavior during Pregnancy with Gestational Diabetes Mellitus among Asian Women in Singapore. BMC Pregnancy and Childbirth (2017).

2.    Diabetes is a serious health concern globally and in Singapore. Globally, it is estimated that the number of people with diabetes between the ages of 20 and 79 years will reach more than 640 million in 2040. Bommer C, et al. Global Economic Burden of Diabetes in Adults: Projections from 2015 to 2030. Diabetes Care (2018). This is equivalent to one diabetic patient for every 10 adults. In Singapore alone, it is projected that a million people will be diagnosed with diabetes by 2050 Based on a 2014 study by Saw Swee Hock School of Public Health, National University of Singapore if we do not do anything about this. Within the spectrum of diabetic conditions, gestational diabetes is of specific concern as proper management of GDM can prevent or delay the onset of diabetes in future. The early detection, intervention and follow-up of GDM patients is therefore a pressing challenge and I hope this meeting will generate even more ideas to tackle this area.

Physical activity and exercise in pregnancy

3.    This year’s Conference focuses on Optimal Lifestyle for Better Metabolic Health. Lifestyle behaviours such as diet and physical activity are the main modifiable risk factors for diabetes and obesity. Indeed, I cannot emphasise enough the importance of exercise in our daily lives to improve overall health and mental wellbeing. Research into the effects of physical activity and exercise in pregnancy have also shown benefits in limiting gestational weight gain and preventing adverse maternal and foetal outcomes. Yet despite evidence suggesting that regular exercise during pregnancy reduces the risk of GDM, pregnant women tend to be less active due to physical and psychological barriers. Nasiri-Amiri F, et al. The Effect of Exercise on the Prevention of Gestational Diabetes in Obese and Overweight Pregnant Women: A Systematic Review and Meta-analysis. Diabetology & Metabolic Syndrome (2019). And indeed, I think very often, it is also cultural factors and mindset. Healthcare professionals who are in frequent contact with pregnant women have a part to play in encouraging pregnant mothers to exercise during their pregnancy.

4.    Today, I am pleased to join you at the launch of the Guidelines on Physical Activity and Exercise in Pregnancy. Developed by a committee of healthcare professionals and clinicians, and supported by IPRAMHO, this is a positive step towards raising awareness of appropriate exercise and weight management before, during and after pregnancy, and correcting mindset. It recommends that women with uncomplicated pregnancies should engage in at least 20 to 30 minutes of moderate-intensity physical activity per day, for a minimum of three days per week, but ideally on most days of the week.

5.    The guidelines also provide clear description of how and what exercise to adopt, as well as the precautionary steps and care to take when exercising in pregnancy. For example, pregnant women in their second trimester should avoid exercises that require them to lie horizontally while exercising as this can lead to aortal-caval compression and hypotension. To avoid low blood sugar and/or dehydration, it is also important for pregnant women to keep their physical activity to not more than 45 minutes.

6.    Endorsed by the Obstetrical & Gynaecological Society of Singapore and the Exercise is Medicine Singapore initiative, the guidelines will be a useful resource for healthcare professionals to provide guidance on pre- and post-natal physical activity for pregnant women to achieve better pregnancy outcomes. I am happy to know that this set of guidelines will be made public and disseminated to all healthcare professionals in Singapore within the next three months.

Research and technology for metabolic health in women and children

7.    Besides providing guidance and education, research and technological advancements can also enhance the prevention and management of gestational diabetes. In June 2017, IPRAMHO was established by KK Women’s and Children’s Hospital (KKH), together with SingHealth Polyclinics and National Health Group Polyclinics, as a unique collaboration to advance metabolic health research in women and children. 

8.    I am indeed delighted to learn how IPRAMHO has leveraged recent advances in technology and mobile phone applications to provide lifestyle interventions for pregnant women and to improve pregnancy outcomes. For example, a trial in KKH is studying the use of wearable continuous glucose monitoring in pregnancy to improve care and compliance of GDM mothers. A pilot study on structured exercise programme found it to be effective in encouraging pregnant women to adopt healthy lifestyles and to avoid excessive weight gain.

9.    The Heath Promotion Board has also worked with KKH to develop a pregnancy app on HealthHub, which has been made publicly available since April 2017. GDM is one of the available tracks in the app. It provides daily personalised action plans, reminders and articles to help the user stay motivated to reach her desired diabetic control goals.

Closing

10.    In closing, I would like to thank the organisers and all participating institutions and delegates for your support in our efforts in tackling diabetes and enabling Singaporeans to lead healthier lives. I wish you a fruitful and successful meeting ahead. Thank you.