Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 105156
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.105156
Abnormal peripheral cellular immune profiles in gestational diabetes mellitus: A meta-analysis
Yan Yang, Quan-Zhou Xiao, Jian Zhou, Ya-Qi Wang
Yan Yang, Ya-Qi Wang, National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Quan-Zhou Xiao, Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Jian Zhou, Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
Author contributions: Yang Y was responsible for conceptualization, methodology, literature search, data collection, investigation, visualization, and original draft writing sections; Xiao QZ and Zhou J were responsible for methodology, literature search, data collection, investigation and visualization; Wang YQ was responsible for supervision, and reviewed the article and made helpful suggestions; All authors contributed to the study conception and design. All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest associated with this publication.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Qi Wang, MD, National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. 238202062@csu.edu.cn
Received: January 15, 2025
Revised: April 24, 2025
Accepted: June 10, 2025
Published online: July 15, 2025
Processing time: 181 Days and 13.1 Hours
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.