Abstract
Pre-pregnancy (pregravid) obesity has been linked to several adverse health outcomes for both mother and offspring. Complications during pregnancy include increased risk for gestational diabetes, hypertension, preeclampsia, placental abruption, and difficulties during delivery. Several studies suggest that these negative outcomes are mediated by heightened systemic inflammation as well as changes in placental development and function. However, the molecular mechanisms by which pregravid obesity affects these processes are poorly understood. In this study, we aimed to address this question by carrying out a comprehensive analysis of the systemic maternal immune system coupled with placental gene expression and microbial profiling at term delivery (11 lean and 14 obese). Specifically, we examined the impact of pregravid obesity on circulating cytokines, chemokine, adipokines, and growth factors using multiplex Luminex assay. Innate and adaptive immune cell frequencies and their cytokine production in response to stimuli were measured using flow cytometry. Finally, changes in placental transcriptome and microbiome were profiled using RNA- and 16S-sequencing, respectively. Pregravid obesity is characterized by insulin and leptin resistance, high levels of circulating inflammatory markers IL-6 and CRP, in addition to chemokine IL-8 (p < 0.01). Moreover, pregravid obesity was associated with lower frequency of naïve CD4+ T-cells (p < 0.05), increased frequency of memory CD4+ T-cells (p < 0.01), and a shift towards Th2 cytokine production (p = 0.05). Myeloid cells from the obese cohort produced higher levels of pro-inflammatory cytokines but lower levels of chemokines following TLR stimulation (p < 0.05). Lastly, pregravid obesity is associated with increased abundance of Bacteroides and changes in the expression of genes important for nutrient transport and immunity (FDR < 0.05). Collectively, these data indicate that pregravid obesity is associated with heightened systemic inflammation and of dysregulated nutrient transport in the placenta and provide insight into the basis of fetal reprogramming.
Highlights
37% of women of reproductive age (20–40 years of age) are considered obese (>30 kg/m2) (Flegal et al, 2016)
Blood samples were collected at 37–38 weeks of gestation in order to determine the impact of pregravid obesity on circulating hormonal and immune factors as well as immune cell frequency and function
In this study, we assessed the impact of pregravid obesity on systemic inflammatory and metabolic factors, frequency and responses of peripheral immune cells as well as the placental transcriptome and microbiome at 37 weeks of gestation
Summary
37% of women of reproductive age (20–40 years of age) are considered obese (>30 kg/m2) (Flegal et al, 2016). Adverse outcomes for the offspring include more frequent admissions to neonatal intensive care unit (NICU) due to bacterial sepsis and necrotizing enterocolitis (Rastogi et al, 2015; Suk et al, 2016), higher incidence of metabolic disease, allergy/wheezing, cancer, as well as altered neurodevelopment (Godfrey et al, 2017). The mechanisms underlying these adverse outcomes are poorly understood, but chronic low-grade maternal inflammation has emerged as a key contributor to the pathophysiological changes associated with pregravid obesity (Denison et al, 2010). Pregravid obesity is associated with transcriptional changes in genes that regulate inflammation, lipid metabolism, insulin resistance, angiogenesis, and hormone activity in the placenta (Saben et al, 2014a,b)
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