When Akhila Krishnamurthy, 36, discovered she had diabetes during the second trimester of her pregnancy, it was “a wake-up call.” While she had a family history of diabetes, she never expected it during the course of an otherwise normal pregnancy.

Krishnamurthy’s diabetes, the kind that manifests during pregnancy, is called gestational diabetes, and it’s becoming increasingly common in India. The International Diabetes Foundation estimates that roughly 5.4 million births in India are affected by gestational diabetes, which, if undetected or mismanaged, can pose great risk to the health of the mother and baby—in some cases, becoming life-threatening.

What is gestational diabetes?

Gestational diabetes occurs when women who have never had diabetes before suddenly develop high blood sugar levels during pregnancy. While the specific cause of gestational diabetes is unknown, onset is generally linked to placental hormones. These hormones help the baby grow, but for some women, they also prevent the mother’s natural insulin from breaking down sugar into energy.

”Most women who have [gestational diabetes] give birth to healthy babies, especially when they keep their blood sugar under control, eat  a  healthy  diet,  get  regular and  moderate  physical  activity,  and  maintain  a  healthy weight,” explains Dr. RM Anjana, of Dr. Mohan’s Diabetes Specialities Centre in Chennai. “However, if it is not managed properly, or goes undetected, it could cause serious  complications  for  both  the  mother  and  baby.”

A too-high birth weight, which increases the need for a Caesarean section delivery, or premature birth are possible outcomes, Dr. Anjana explains. Birth defects, miscarriage, and stillbirth are also possible, though worst-case scenarios, of poorly managing gestational diabetes.

Gestational diabetes symptoms and risk factors

While gestational diabetes is a condition that can affect any woman at any time during pregnancy, there are some factors that leave you more vulnerable. Dr. Anjana says the risk is highest for:

• Women older than 25
• Women who were overweight or obese prior to pregnancy
• Women of Indian heritage
• Women who have developed gestational diabetes during previous pregnancies
• Women with parents, siblings or children who have diabetes

Symptoms of gestational diabetes aren’t obvious, and that’s why screening in the first trimester is so important, says Dr. J Sangumani, a diabetologist and professor at Madurai Medical College.

“Because of our (Indians’) genetic predisposition to diabetes, it is essential for every Indian woman to test for diabetes as early as possible during pregnancy,” Dr Sangumani says.

Very rarely, he says, do obvious symptoms of gestational diabetes manifest; sweating, palpitation, headache, and giddiness can all be signs of extreme low blood sugar, but it is best not to wait for them to appear. A history of urinary infections and frequent headaches may also signal gestational diabetes, so give your doctor a full description of your medical history from the start of your pregnancy.

Gestational diabetes treatment

A gestational diabetes diet plan is the best way to manage the condition.

“During pregnancy, a woman’s energy needs increase,” says Dr Sangumani. “A woman with gestational diabetes is advised to [eat] 30 calories per kilogram of body weight every day. The majority of your diet should come from complex carbohydrates.”

Complex carbohydrates like green vegetables, whole grains, starchy vegetables and dals, release sugar slowly and steadily into the bloodstream. Dr Sangumani also says making protein only 20 to 30 percent of the diet can help with managing gestational diabetes.

Viji Kumar, 30, remembers well the difference her diet made in managing her gestational diabetes. But it wasn’t easy, she says; it took determined effort, discipline, and willpower.

“The hardest part about having diabetes during pregnancy was not able to indulge in the foods I enjoyed,” she says. “The health of my baby was a priority, so I had to plan my meals carefully. I avoided [white] rice, sweets, table sugar, milk. Instead, I ate roti (chapathi) and vegetables. Greens became a staple part of my diet.”

For Krishnamurthy, too, switching to traditional whole grains helped.

“My mother made innovative recipes from millet, cracked wheat, bajra,” she says. ”If I ate a paratha, or even a tiny portion of white rice, my sugar levels would shoot up. It was such an eye-opener.”

The experience of combining the right gestational diabetes diet and exercise stuck with her: Even today, despite the fact that her blood sugar levels normalized after birth, Krishnamurthy is still very aware of how many complex carbs she consumes and never skips exercise.

While many women’s blood sugar levels normalize after birth, having gestational diabetes during one pregnancy increases the risk during future pregnancies, says Dr. Anjana. To avoid this, she advises monitoring blood glucose (sugar) from the very beginning of any subsequent pregnancies. Ultimately, managing gestational diabetes well can be the earliest and most lasting gift you give your baby; a healthy diet, regular exercise, and a healthy weight can benefit you and your little one well past pregnancy.