Speech by Dr Amy Khor, Senior Minister of State for Health, at Asia Pacific Diabetes in Pregnancy Conference, 11 January

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

Associate Professor Ng Kee Chong, Chairman, Medical Board, KK Women’s and Children’s Hospital 

Professor Ounjai Kor-anantakul, Chair Maternal & Fetal Medicine Committee of Asia-Oceania Federation of Obstetrics & Gynaecology (AOFOG) 

Professor Tan Kok Hian, Chairman, Organising Committee of the Asia Pacific Diabetes in Pregnancy Conference & President of Perinatal Society of Singapore 

Distinguished guests 

Ladies and Gentlemen 

Good afternoon.

1.   It is indeed my pleasure to return here and speak again at the Asia Pacific Diabetes in Pregnancy Conference, and the Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children, or IPRAMHO International Meeting today. 

2.   Diabetes, obesity, and gestational diabetes mellitus, or GDM, is a worldwide challenge. Asians are particularly prone to diabetes and gestational diabetes. 60% of the world’s diabetic population is Asian. We currently face a high prevalence of GDM in Singapore, where an estimated one in five pregnancies is complicated by the condition. While this is of concern, the detection of GDM among women creates opportunities to intervene early in the diabetes epidemic.

Importance of maternal health and perinatal nutrition 

3.   The best preventive efforts start upstream from pre-conception through to conception, and to the early childhood years. The strategy for Singapore’s ‘War on Diabetes’ must therefore begin with effective battles against diabetes at this early stage. 

4.  The conference’s theme of Optimal Perinatal Nutrition for Better Metabolic Health, focussing on perinatal nutrition, is a strategic one. Besides developing GDM during pregnancy, excessive and unhealthy eating by mothers can increase the risk of complications such as macrosomic babies¹, and increase the babies’ subsequent predisposition to non-communicable diseases (NCDs) and obesity throughout his/her life. 

5.  There is now increasing evidence from international studies as well as local cohort studies in Singapore for the need to optimise perinatal nutrition. This is because the first thousand days, from conception to age two, influence long term health and development of the child. New evidence also shows that adverse Body Mass Index (BMI) trajectories in childhood can only be successfully modified through interventions made before six years of age. 

6.  In light of these developments, I am heartened by how both IPRAMHO and the Perinatal Society of Singapore has taken the initiative to develop guidelines for their fellow health care practitioners, which will be launched today. The Guidelines on Optimal Perinatal Nutrition were produced by a group² initiated by Prof Tan Kok Hian and chaired by Dr Chua Mei Chien, which involves obstetricians, neonatologists, paediatricians, and dieticians from across institutions and disciplines. The guidelines were also developed with reference to local research findings, as well as recommendations from other international bodies, such as the World Health Organization (WHO) and the United Kingdom’s National Institute for Health and Care Excellence (NICE). 

7.   The new perinatal guidelines have integrated advice across the perinatal continuum in a holistic fashion. They are relevant to healthcare professionals for use in their practice and can advise pregnant mothers toward a healthier pregnancy. There is also an emphasis on screening for all women and children before conception, in pregnancy and after pregnancy. As parents want to give children the best start in life, such a start begins with good nutrition.

Exclusive breastfeeding as part of perinatal nutrition 

8.   Exclusive breastfeeding, a component of perinatal nutrition, is therefore key to giving our children the best start in life. It provides the essential energy and nutrients needed for optimal growth and development, as well as protection against infectious and chronic diseases. For example, breastfed infants are 22% less likely to be obese³ compared to infants who were never breastfed⁴, thus showing the importance of breastfeeding amid growing obesity rates in both developing and developed world. The benefits of breastfeeding also extend to mothers, where it is associated with a decrease in the incidence of both breast and ovarian cancers, as well as Type 2 diabetes, hypertension, and cardiovascular disease⁵.

9.    It is heartening to see that more mothers are breastfeeding in Singapore. But more can be done to promote breastfeeding. In this aspect, I am encouraged by the strong commitment of our healthcare professionals in supporting breastfeeding. The revised Joint Statement on Breastfeeding and Optimal Milk Feeding for Infants and Young Children has just been promulgated in November last year, by all relevant professional colleges, chapters, associations, and societies in Singapore⁶. This demonstrates the important role that healthcare professionals can play in encouraging and supporting breastfeeding in the community. 

10.  In tandem, the work of the Sale of Infant Foods Ethics Committee, Singapore, or SIFECS, provides a framework to guide healthcare professionals in their interactions with the infant nutrition industry. This ensures that the support for breastfeeding and optimal infant nutrition is not compromised in any way. I am pleased to announce the launch of the 5th edition of the SIFECS Code today, which has been revised so that it remains relevant to the changing landscape of industry and consumer needs. The scope of the new Code has been expanded from 0-6 months to 0-12 months, and there is also an expansion of sponsorship restrictions, to reduce the reliance on infant formula by mothers. This includes prohibiting infant formula companies from providing both financial and in-kind inducements for hospitals to promote particular brands of infant formula to mothers.

Hospitals a key stakeholder 

11.    A key stakeholder in perinatal nutrition and infant health is the hospitals. In 2017, the Ministry of Health (MOH) called for all maternity hospitals, including private hospitals, to come on-board the Baby-Friendly Hospital Initiative (BFHI). This initiative was launched by the WHO and UNICEF, to provide a conducive environment for successful breastfeeding and optimal nutrition for babies from birth.

12.   I am pleased to note that by 2020, all nine maternity hospitals in Singapore will be BFHI-certified⁷. In mid-December last year, Mount Elizabeth Novena Hospital became the first private hospital to become certified. Other hospitals under the Parkway Pantai Hospital Group and Raffles Hospital are on track. Thomson Medical Centre and Mount Alvernia Hospital have also committed to be BFHI-certified by 2020. 

13.  HPB is supporting our maternity hospitals in achieving and maintaining BFHI certification, by co-developing e-modules on breastfeeding education together with healthcare professionals. These e-modules can count towards doctors’ Continuing Medical Education (CME) requirements and could be easily accessed through login to the Academy of Medicine Singapore (AMS) website, under the Self-Learning Module (SLM). These courses will equip healthcare professionals with essential knowledge on breastfeeding for clinical practice. This is a convenient and effective way for hospital staff to be trained in order to support mothers in their breastfeeding journey. It also helps to address the challenge faced by healthcare professionals in complying with the requisite training for BFHI certification. 

Conclusion 

14.   In closing, I would like to thank IPRAMHO, KKH, and all the participating institutions in their efforts to support Singapore’s War on Diabetes. This will help to realise the vision of enabling Singaporeans to lead healthier lives. I hope this conference will inspire you to collectively work towards the betterment of the health of our women and children. I wish you all a fruitful and successful meeting. 

Thank you.

¹ This refers to a new born who is significantly larger than average. 
² Perinatal Society of Singapore Advocacy Group for Engagement on Optimal Perinatal Nutrition (PAGE OPEN).
³ Bernardo L Horta and Cesar G Victora, ‘Long-term effects of breastfeeding: A Systematic Review’, World Health Organization Publications (2013) 
⁴ Melinda McNiel et al, ‘What are the Risks Associated with Formula Feeding? A Re-Analysis and Review’, Birth Issues in Perinatal Care, 37 (2010) 
⁵ MS Kramer and R Kakuma, ‘Optimal duration of exclusive breastfeeding: A Systematic Review’, Cochrane Database Systematic Review, (2002); Stanley Ip et al, ‘Breastfeeding and maternal and infant health outcomes in developed countries [Review]’, Evidence Reports/Technology Assessments, 153 (2007). 
⁶ Academy of Medicine, College of Obstetricians & Gynaecologists, College of Paediatrics & Child Health, Chapter of Family Medicine Physicians, College of Public Health & Occupational Physicians, Association of Breastfeeding Advocacy (Singapore), Obstetrical & Gynaecological Society of Singapore, Singapore Paediatric Society, Perinatal Society of Singapore, and Singapore Nutrition and Dietetics Association.
⁷ This includes three restructured hospitals (Singapore General Hospital, KK Women’s and Children’s Hospital, and National University Hospital), and six private hospitals (Raffles Hospital, Mount Elizabeth Novena, Mount Elizabeth Orchard, Gleneagles, Mount Alvernia Hospital and Thomson Medical Centre)