The role of ımmune cells in the placenta of gestational diabetes patients: does ıt offer hope for targeted treatment?

BACKGROUND: Gestational diabetes mellitus (GDM) is a prevalent metabolic complication that arises during pregnancy, posing significant health risks for both mother and fetus. The placenta is not only affected by GDM but also actively contributes to its pathogenesis and maternal-fetal outcomes. This complex interaction makes it difficult to fully understand the etiology of GDM and its effects on the placenta. In this study, we aimed to clarify the pathogenesis of GDM by evaluating the role of inflammation and describing the macroscopic and histopathological changes in placentas affected by GDM. METHODS: This study compared 50 singleton pregnancies complicated by GDM with 50 normoglycemic pregnancies. All deliveries occurred at term. Placentas were examined both macroscopically and microscopically. Immunohistochemical staining was performed for the following markers: CD4, CD8, CD68, CD80, CD86, and CD206. RESULTS: Placental weight and diameter were significantly higher in the GDM group compared to the control group (p < 0.001). GDM placentas showed a significantly higher frequency of chorangiosis, villous edema, villous immaturity, and ischemic changes (p < 0.001). Immunohistochemical analysis revealed increased expression of CD4, CD8, CD68, CD80, and CD86, while CD206 expression was significantly reduced in the GDM group (p < 0.001). DISCUSSION: These findings support the central role of placental inflammation and macrophage polarization shifts in the pathogenesis of GDM. They also highlight potential targets for developing new diagnostic biomarkers and anti-inflammatory or immunomodulatory therapeutic strategies.