Published Apr 07, 2026 | 8:34 AM ⚊ Updated Apr 07, 2026 | 8:34 AM
Gestational Diabetes. Representative Image.
Synopsis: A new study found that women with a history of gestational diabetes face eight to ten times the risk of developing type 2 diabetes, with that risk peaking within the first five years after delivery. Yet in Kerala, postpartum diabetes screening rates sit at just 29 percent. The study says the primary reason behind the issue is the dietary pattern, which includes high sugar.
Every year, thousands of women in Kerala receive a diagnosis of gestational diabetes mellitus. Most manage it through pregnancy. Most assume it ends there.
It does not.
A new study by researchers at Aster Medcity and Amrita Institute of Medical Sciences found that women with a history of gestational diabetes face eight to ten times the risk of developing type 2 diabetes, with that risk peaking within the first five years after delivery. Yet in Kerala, postpartum diabetes screening rates sit at just 29%.
The study, which draws on in-depth interviews and focus group discussions with mothers, ASHA workers, and clinicians, identifies something that blood glucose tests cannot capture: the weight of culture.
In Kerala, the weeks after childbirth follow a well-worn script. Mothers rest indoors. Elders cook. Tradition governs the table.
That tradition includes three bananas a day, generous servings of ghee, and a preparation known as lehyam. Each carries cultural meaning. Each also carries calories that push well beyond the 2,500 to 2,800 kcal recommended for lactating women.
One participant in the study described how she watched a relative with gestational diabetes consume these preparations without apparent consequence.
“Despite having gestational diabetes, my sister-in-law had no problems using lehyam and other traditional postpartum medicines,” she said. “After consulting with her, I am likely to adopt similar postpartum care practices myself.”
The logic flows through generations. Elderly women pass nutritional customs down through oral tradition. New mothers, inexperienced and uncertain, defer to them. Medical advice enters the household last, if at all.
One belief cuts across households: A mother must eat more than she wants, because the baby receives only a fraction of what she consumes.
The study documents how this shapes behaviour in ways that directly increase diabetes risk.
“I don’t believe food alone causes diabetes,” one participant said. “Elders say we need to eat more than necessary, as the baby only gets about one-fifth of what we eat. Despite feeling breathing difficulties, I push myself to eat as much as I can for both my own well-being and the baby’s.”
Women also reported a widespread assumption that gestational diabetes resolves the moment the baby arrives. Once delivery happens, many believe they could return to their previous eating habits without consequence.
The study finds this misconception goes largely unchallenged by the healthcare system.
Food in many Kerala households does not belong to the woman who eats it. It belongs to whoever prepares and decides it.
The study describes a layered power structure in which mothers-in-law direct postpartum meals, daughters-in-law follow instructions, and the woman’s own medical history rarely enters the conversation. In some households, domestic workers prepare traditional meals based on custom alone, with no reference to dietary guidance.
“I always prioritise family needs over my needs,” one participant said. “I can only choose to delay my needs. That’s the essence of being a mother; that’s what I learned.”
The researchers note that this pattern reflects broader gender dynamics. Despite high literacy rates and growing employment among women, Kerala’s households retain structures where women hold limited authority over decisions that concern their own bodies.
Healthcare providers carry part of this burden, too.
The study finds that antenatal consultations focused narrowly on managing blood glucose during pregnancy. Postpartum risks received little attention. Consultations often ran no longer than ten minutes. Women left with the impression that once the pregnancy ended, the danger passed.
“My doctor never warned me that diabetes might set in eventually,” one participant said. “All she said was that after the delivery, my gestational diabetes would go away.”
Researchers found that blood glucose screening typically occurs once, around 45 days after delivery, and then stops. No further routine checks follow. The clinical guideline exists; the follow-through does not.
Lifestyle change requires time, energy and a degree of control. The study finds that postpartum women in Kerala often lack all three.
Sleep deprivation arrives with the newborn and stays. Cultural norms discourage rest during family visits. Women who attempt to sleep when relatives come to the house report being perceived as disrespectful.
Stress compounds this. Women described anxiety about delivery, household management and the absence of spousal support. They also described raising these concerns with healthcare providers and receiving little in response.
“Since the onset of my pregnancy, I have been overwhelmed with anxiety about the challenges of delivery,” one participant said. “When I share my concerns with my doctor, she offers little reassurance, merely providing a consultation without addressing my emotional distress.”
Exercise, meanwhile, carries its own cultural resistance. Many women reported being discouraged from physical activity during and after pregnancy. Rest carries social approval. Movement does not.
Some women looked for help beyond the clinic. They downloaded health apps. They searched for dietary guidance online.
What they found did not fit their lives.
“I subscribed to an app for a month, but didn’t use it much because the recipes were not from Kerala cuisine,” one participant said. “I found the dishes challenging to follow and not aligned with my preferences.”
The study identifies this as a design failure, not a motivation failure. Digital health tools that carry nutritional value but strip local context ask women to abandon not just a diet but an identity.
The researchers argue that gestational diabetes needs to be repositioned, not just clinically but culturally. It is not a temporary condition of pregnancy. It is an early signal of metabolic risk that extends years beyond delivery.
Fixing that requires more than better leaflets. The study calls for community-based interventions that work within family structures rather than against them. It recommends that ASHA workers take on a follow-up role, that screening reminders integrate into routine immunisation visits, and that dietary guidance adapt to what Kerala families actually eat.
It also calls on the healthcare system to extend conversations beyond ten minutes.
Without that, the study concludes, Kerala’s already considerable diabetes burden among women will grow. The culture that shapes these women’s lives will continue to shape their illness, too, unless the system finds a way to meet them inside it.
(Edited by Muhammed Fazil.)
