Gestational Diabetes and T-cell (Th1/Th2/Th17/Treg) Immune Profile

Abstract

Background/aim: Gestational diabetes mellitus (GDM) is a common pregnancy complication, characterized by insulin resistance and low-grade systemic inflammation with a pro-inflammatory immune system response. Our objective was to study the peripheral Th1, Th2, Th17 and Treg response in GDM compared to normal pregnancy.

Materials and methods: Th1, Th2, Th17 and Treg subsets was determined by flow cytometry based on staining for specific intracellular cytokines, as well as C-reactive protein (CRP) and total IgE circulating levels. The health status of all offspring was also assessed 6 months post-delivery.

Results: A total of 49 Caucasian adult pregnant women were enrolled into a GDM (n=26) and Control (n=23) group. At the third trimester of pregnancy, the GDM group had a higher proportion of Th2, Th17 and Treg cells compared to control. Contrary to the control group, the GDM group exhibited no significant change in the Th1/Th2/Th17/Treg profile postpartum. Furthermore, higher circulating CRP and total IgE levels were noted in the GDM group compared to controls. At the 6-month post-delivery assessment, 30.8% of the offspring from the GDM group were found to have developed atopic dermatitis, food allergy or allergic proctocolitis compared to none from the control group.

Conclusion: Compared to an uncomplicated pregnancy, GDM exhibits a significantly different peripheral T-cell profile at the third pregnancy trimester characterized by higher proportion of Th2, Th17 and Treg cells which persist six months post-delivery, while the increased high sensitivity CRP (hsCRP) levels stressed the low-grade inflammatory profile of this disease.

Keywords: GDM; Gestational diabetes; T-cells; Th1; Th1/Th2/Th17/Treg immunologic profile; Th17; Th2; Treg; pregnancy complications.

Figure 1. Box plots representing the percent proportion of IFN-γ+, IL-13+, IL-17+ and IL-10+ T-cell subpopulations among CD3+CD4+ lymphocytes in the recruited women with gestational diabetes (GDM group) and healthy controls (Control group) at the third pregnancy trimester (28th-34th gestational week) and 6 months post-delivery. Horizontal line: median; box: interquartile range. p-Values<0.05 were regarded significant. IFN-γ: Interferon gamma; IL-13: interleukin 13; IL-17: interleukin 17; IL-10: interleukin 10; Th1: T-helper 1 cells; Th2: T-helper 2 cells; Th17: T-helper 17 cells; Treg: regulatory T cells.