The immunological profile of maternal obesity at 28 weeks of gestation
underpins common negative pregnancy outcomes
Abstract
Healthy pregnancy is accompanied by various immunological and metabolic
adaptations. Maternal obesity has been implicated in adverse pregnancy
outcomes such as miscarriage, preeclampsia, and gestational diabetes
mellitus (GDM), while posing a risk to the neonate. There is a lack of
knowledge surrounding obesity and the maternal immune system. The
objective of this study was to consider if immunological changes in
pregnancy are sabotaged by maternal obesity. Peripheral blood was
collected from fasted GDM-negative pregnant women at 26-28 weeks of
gestation. Analysis was done using immunoassay, flow cytometry,
bioenergetics analysis and cell culture. The plasma profile was
significantly altered with increasing BMI, specifically leptin
(r=0.7635), MCP-1 (r=0.3024) and IL-6 (r=0.4985). Circulating leukocyte
populations were also affected with changes in the relative abundance of
intermediate monocytes (r=-0.2394), CD4:CD8 T cell ratios (r=0.2789),
and NKT cells (r=-0.2842). Monocytes analysed in more detail revealed
elevated CCR2 expression and decreased mitochondrial content. However,
LPS-stimulated cytokine production and bioenergetic profile of MNCs was
not affected by maternal BMI. The Th profile skews towards Th17 with
increasing BMI; Th2 (r=-0.3202) and Th9 (r=-0.3205) cells were
diminished in maternal obesity, and CytoStimTM-stimulation exacerbates
IL-6 (r=0.4166), IL-17A (r=0.2753), IL-17F (r=0.2973) and IL-22
(r=0.2257) production with BMI, while decreasing IL-4 (r=-0.2806).
Maternal obesity during pregnancy creates an inflammatory
microenvironment. Successful pregnancy requires Th2-biased responses yet
increasing maternal BMI favours a Th17 response that could be
detrimental to pregnancy. Further research should investigate key
populations of cells identified here to further understand the
immunological challenges that beset pregnant women with obesity.