Abnormal peripheral cellular immune profiles in gestational diabetes mellitus: A meta-analysis

Abstract

BACKGROUND

Gestational diabetes mellitus (GDM) has recently been associated with abnormal profiles of inflammatory cells and cytokines, though the findings remain inconsistent and unclear.

AIM

To elucidate the peripheral immune status in GDM.

METHODS

We systematically screened databases including Web of Science, PubMed, and EMBASE for eligible studies. Original articles reporting different immune cell levels in GDM compared to normal glucose-tolerance pregnant women were included to extract usable data. The pooled mean difference (MD) with 95% confidence interval (CI) was analyzed as the outcome measure. The Newcastle-Ottawa scale was employed to assess study quality.

RESULTS

A total of 19 studies involving various immune cell subgroups were included in our analysis. Specifically, total CD4+ T cells (WMD = 3.08; 95%CI: 0.81-5.35) were significantly increased in GDM groups. In contrast, total lymphocytes (SMD = 0.05; 95%CI: -0.16 to 0.26), CD3+ T cells (SMD = -0.34; 95%CI: -1.01 to 0.32), CD8+ T cells (SMD = 0.21; 95%CI: -0.31 to 0.73), and natural killer T (NKT) Cells (SMD = 0.83; 95%CI: -1.10 to 2.75) showed no significant changes in GDM. Activation markers (HLA-DR+ or CD69+) on CD4+ T cells (WMD = 0.20; 95%CI: 0.06-0.34) were increased in GDM patients. Treg cells, a classical subgroup of CD4+ T cells, showed a decreasing trend in GDM compared to controls (SMD = -0.83; 95%CI: -1.31 to -0.34). These results indicate an abnormal immune status in the peripheral profiles of GDM.

CONCLUSION

GDM may not only be a dysglycemia-related condition but also an immune disorder characterized by abnormal peripheral immune profiles, including higher levels of CD4+ T cells and a reduced population of Treg cells. Treating immune dysregulation could be a new direction for GDM management, although further research is needed to understand the precise mechanisms of immune overactivation in GDM.

Keywords: Gestational diabetes mellitus; Peripheral immune cell; Immune dysregulation; Meta-analysis

Core Tip: Gestational diabetes mellitus (GDM) affects pregnancies globally, leading to serious complications for both mothers and their offspring. GDM is associated with immune dysregulation, including alterations in immune cell profiles. This study analyzed 19 studies and found increased CD4+ T cells and reduced Treg cells in GDM patients, indicating an abnormal immune response. Other immune cells, like CD3+ T cells and NK cells, showed no significant changes. The findings suggest that GDM may not only involve dysglycemia but also immune disorders, highlighting the potential for immune-targeted therapies in GDM management.