Immunologic profile in normal and diabetic pregnancy

Doctoral Dissertation uoadl:2867922 145 Read counter

Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
Sifnaios Emmanouil
Dissertation committee:
1. Γεώργιος Κρεατσάς, Ομότιμος Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
2. Νικόλαος Βιτωράτος, Ομότιμος Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
3. Γεώργιος Μαστοράκος, Τακτικός Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
4. Νικόλαος Βλάχος, Ομότιμος Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
5. Κωνσταντίνος Πανουλής, Αναπληρωτής Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
6. Δημήτριος Ρίζος, Αναπληρωτής Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
7. Μακάριος Ελευθεριάδης, Επίκουρος Καθηγητής, Ιατρική, Ε.Κ.Π.Α.
Original Title:
Ανοσολογικό προφίλ φυσιολογικών και διαβητικών κυήσεων
Translated title:
Immunologic profile in normal and diabetic pregnancy
Background: 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. The levels of allergic sensitization was also checked in all, non-symptomatic for the rest, individuals.

Methods: GDM and control pregnant women were assessed at the third trimester and 6 months postpartum. At both timepoints, the proportion of 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. In peripheral blood, specific IgE antibodies were measured for six aeroallergens as well as total IgE and hsCRP values. Skin tests for the aforementioned allergens were performed only postpartum, while assessing the health status of the offspring.

Results: 49 Caucasian adult pregnant women were enrolled into a GDM (n=26) and Control (n=23; healthy BMI/age-matched women) group. At the third trimester of pregnancy, the GDM group had a higher proportion of Th2, Th17 and Treg cells compared to control (all p-values ≤0.001). Contrary to the control group, the GDM group exhibited no significant change in the Th1/Th2/Th17/Treg profile postpartum. Furthermore, in the GDM group higher circulating CRP and total IgE levels were noted compared to controls at both timepoints (all p-values <0.05), which remained practically unchanged post-delivery. The same applies to the allergic sensitization in diabetics. Regarding the results of the skin tests (clinical-laboratory testing) carried out at six months post-partum, there was no agreement with the corresponding laboratory test used for the detection of IgE antibodies against allergens both before and after birth. At the 6-month post-delivery assessment, eight (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 (p=0.01).

Conclusions: These findings indicate that, compared to 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 persists six months post-delivery, while the increased high sensitivity CRP (hsCRP) levels stressed the low grade inflammatory profile of this disease. Gestational diabetes, as a mild inflammatory and immunologically disrupted environment, could be associated with increased predisposition towards atopy in the future through epigenetic effects.
Main subject category:
Health Sciences
Gestational Diabetes, Immunology, Atopy, T lymphocytes
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