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I frowned at the orange soda. Recalling its sickeningly sweet taste, I cringed and forced myself to drink it as quickly as I could. The nurse set a timer, and I felt a knot form in my stomach as I waited for the results. Soon after, the test confirmed elevated blood sugar levels; I had gestational diabetes.
This was not even on my radar. I’d had no warning signs (which I later learned was often the case). My obstetrician referred me to a dietitian specializing in diabetes prevention and management. During our session, I found myself staring at menus of vibrant vegetables, whole grains, and animal-based proteins. My lifestyle and identity were not represented. These were not the foods I grew up with. Where were the dals, the lentils, the staple proteins that my ancestors had traditionally turned to for sustenance for centuries?
As an Indian American woman, I had to quickly learn how to advocate for a healthy pregnancy while honoring my cultural identity in a system that favors a one-size-fits-all model. It shouldn’t be this way. All women deserve access to prenatal care that addresses their individual needs and identities. Earlier this year, the American College of Obstetricians and Gynecologists released new recommendations for personalized prenatal care. This was an encouraging first step in supporting the diverse cultural, social, and structural needs of expectant mothers. Now, it is time that we put these recommendations into practice.
Rates of gestational diabetes in the US are increasing, with about 8 of every 100 births impacted each year. Women who are less active or have a higher body mass index may be at increased risk of developing gestational diabetes. Indian women in the US experience the highest rates of gestational diabetes, with about 16 of every 100 births impacted. Diagnosing and managing the condition is important because of potential risks. These risks include increased neonatal birth weight, high maternal blood pressure, and increased long-term maternal risk of developing type 2 diabetes.
As a prevention scientist, I immediately sought ways to adjust my lifestyle to manage the condition. While lifestyle changes alone might not work for everyone, my obstetrician shared that this approach was often successful.
I have been a vegetarian since birth. Being vegetarian is not only a part of my lifestyle but a deep part of my Indian heritage and identity. Growing up as a vegetarian, following in my ancestors’ footsteps, and choosing to sustain this lifestyle as an adult are rooted in my ancestral Jain value of ahimsa, which advocates for peace and respect for all life. This value was handed down, modeled generation to generation.
As it turned out, my one-hour session with the dietician proved to be one of the most impactful clinical experiences I have ever had. I learned about reading food labels, tracking dietary intake, and making informed decisions about my daily choices. It also made me realize that, over the years, I had confused the concepts of vegetarianism and a plant-based diet. I realized that because of convenience, I was consuming an imbalanced amount of pasta and bread, misaligned with my Indian vegetarian diet.
Turning to my mom, I shared my anxiety about feeling compelled to follow the prescribed types of diets. She reassured me that generations of women have had healthy pregnancies and babies while on a traditional Indian vegetarian diet. I learned to integrate our ancestral foods in combination with strategies I learned from the dietitian. I replaced convenient, simple starches with pre-cut vegetables. I pre-cooked and froze traditional Indian vegetarian dishes consisting of dals, vegetables, herbs, and spices.
These changes allowed me to honor my cultural identity and values while simultaneously managing my gestational diabetes. And during subsequent prenatal care visits, my obstetrician confirmed that my glucose levels had gone down back to normal.
Years later, I continue to apply the lessons I learned during my pregnancy every day, practicing prevention through my lifestyle choices and advocating for culturally inclusive care. Yet the memories of this experience remain with me. As a nation, we should have truly personalized prenatal care to provide equitable access and meet the diverse cultural needs and identities of all expectant mothers. Indian American women should feel fully included and supported to lead in their own health decision-making. Prenatal care combined with lifestyle changes specific to my Jain Indian values allowed me to maintain a healthy pregnancy without sacrificing who I am.