Gestational diabetes mellitus in women increased the risk of neonatal infection via inflammation and autophagy in the placenta

Medicine (Baltimore). 2020 Oct 2;99(40):e22152. doi: 10.1097/MD.0000000000022152.


Background: Gestational diabetes mellitus (GDM) produces numerous problems for maternal and fetal outcomes. However, the precise molecular mechanisms of GDM are not clear.

Methods: In our study, we randomly assigned 22 pregnant women with fasting glucose concentrations, 1 hour oral glucose tolerance test (1H-OGTT) and 2 hour oral glucose tolerance test (2H-OGTT), different than 28 normal pregnant women from a sample of 107 pregnant women at the First Affiliated Hospital of Jinan University in China. Lipopolysaccharide (LPS), interleukin 1 alpha (IL-1α), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha (TNF-α) were measured from blood plasma of pregnant women and umbilical arteries using ultraviolet spectrophotometry. Hematoxylin & Eosin (H&E), Periodic acid-Schiff (PAS) or Masson staining were performed to examine whether diabetes mellitus altered the morphology of placenta. Quantitative PCR (Q-PCR), western blotting and immunofluorescent staining were performed to examine whether diabetes mellitus and autophagy altered the gene expressions of the placental tissue.

Results: We found that women with GDM exhibited increased placental weight and risk of neonatal infection. The concentrations of IL-6 protein and IL-8 protein in GDM were increased in both maternal and umbilical arterial blood. H&E, Masson and PAS staining results showed an increased number of placental villi and glycogen deposition in patients with GDM, but no placental sclerosis was found. Q-PCR results suggested that the expression levels of HIF-1α and the toll like receptor 4 (TLR4)/ myeloid differential protein-88 (MyD88)/ nuclear factor kappa-B (NF-κB) pathway were increased in the GDM placenta. Through Western Blotting, we found that the expression of NF-kappa-B inhibitor alpha (IKBα) and Nuclear factor-κB p65 (NF-κB p65) in GDM placenta was significantly enhanced. We also showed that the key autophagy-related genes, autophagy-related 7 (ATG7) and microtubule-associated protein 1A/1B-light chain 3 (LC3), were increased in GDM compared with normal pregnant women.

Conclusions: Our results suggest that women with GDM exhibit an increased risk of neonatal infection via inflammation and autophagy in the placenta.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Diabetes, Gestational / blood*
  • Diabetes, Gestational / genetics
  • Female
  • Fetal Blood
  • Glucose Tolerance Test
  • Humans
  • Hypoxia-Inducible Factor 1, alpha Subunit / blood
  • Infant, Newborn
  • Inflammation / blood
  • Inflammation / genetics
  • Placenta / microbiology
  • Placenta / pathology*
  • Pregnancy
  • Pregnancy Outcome
  • Toll-Like Receptor 4 / blood


  • HIF1A protein, human
  • Hypoxia-Inducible Factor 1, alpha Subunit
  • TLR4 protein, human
  • Toll-Like Receptor 4