{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:58:38Z","timestamp":1790657918636,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gestational diabetes mellitus (GDM) is amongst the commonest complications of pregnancy and an early marker of lifetime cardiovascular\u2013kidney\u2013metabolic (CKM) risk. Its burden is heavy in Southeast Asia, where prevalence ranges from about 8% to nearly 30% and a lean phenotype \u2014 with marked over-representation of the insulin-secretion-limited subtype \u2014 diverges from Western cohorts, yet its definition, timing, and treatment remain contested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This clinically oriented narrative review synthesises the diagnostic landscape, the shift to early diagnosis, the vascular mechanism, and precision care, centred on Southeast Asia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key themes<\/jats:title>\n                    <jats:p>Competing criteria (IADPSG one-step, WHO 2013, NICE, ADA two-step and the pragmatic Indian DIPSI test) identify different populations. The TOBOGM trial shows that early (pre-20-week) treatment improves outcomes, and first-trimester biomarkers\u2014low adiponectin and sex-hormone-binding globulin, glycosylated fibronectin, atherogenic lipids, and multimarker or machine-learning panels including a non-fasting Asian-women panel\u2014show potential to make early prediction feasible. Vascular and endothelial dysfunction (oxidative stress, eNOS uncoupling, sFlt-1\/PlGF imbalance, and arterial stiffness) is proposed as the unifying early signal and a mechanistic bridge to later type 2 diabetes, cardiovascular disease, and chronic kidney disease. GDM is increasingly recognised as heterogeneous (insulin-resistant, insulin-deficient, and mixed subtypes), inviting subtype- and phenotype-guided precision diagnosis and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We propose that GDM may be productively reframed as an early, vascular, and potentially precisely treatable CKM event\u2014screened early, matched to phenotype and linked to lifelong follow-up, and fitted to the epidemiology, genetics, and health systems of Southeast Asia. This reframing is a testable hypothesis that requires prospective validation before routine adoption.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1949130","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:39:13Z","timestamp":1790656753000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The CKM\u2013GDM multi-organ precision model: reframing gestational diabetes as an early cardiovascular\u2013kidney\u2013metabolic event in Southeast Asia"],"prefix":"10.3389","volume":"17","author":[{"given":"Ashutosh","family":"Mishra","sequence":"first","affiliation":[{"name":"Panacea Multispeciality Hospital","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109050","article-title":"IDF Diabetes Atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by IADPSG criteria","volume":"183","author":"Wang","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18031272","article-title":"Gestational diabetes mellitus in Southeast Asia: a scoping review","volume":"18","author":"Kunasegaran","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnac003","article-title":"A clinical update on gestational diabetes mellitus","volume":"43","author":"Sweeting","year":"2022","journal-title":"Endocr Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00655","article-title":"Mechanisms of endothelial dysfunction in pre-eclampsia and gestational diabetes mellitus: windows into future cardiometabolic health","volume":"11","author":"McElwain","year":"2020","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B5","article-title":"Criteria for the oral glucose tolerance test in pregnancy","volume":"13","author":"O\u2019Sullivan","year":"1964","journal-title":"Diabetes"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(82)90349-0","article-title":"Criteria for screening tests for gestational diabetes","volume":"144","author":"Carpenter","year":"1982","journal-title":"Am J Obstet Gynecol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1056\/NEJMoa0707943","article-title":"Hyperglycemia and adverse pregnancy outcomes","volume":"358","year":"2008","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1848","article-title":"Recommendations on the diagnosis and classification of hyperglycemia in pregnancy","volume":"33","year":"2010","journal-title":"Diabetes Care"},{"key":"B9","volume-title":"Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy","year":"2013"},{"key":"B10","volume-title":"Diabetes in Pregnancy: Management From Preconception to the Postnatal Period (NG3)","year":"2015"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S015","article-title":"15. 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