Wierzchowska-Opoka Magdalena, Grunwald Arkadiusz, Rekowska Anna K, Łomża Aleksandra, Mekler Julia, Santiago Miracle, Kabała Zuzanna, Kimber-Trojnar Żaneta, Leszczyńska-Gorzelak Bożena
Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-059 Lublin, Poland.
Vaccines (Basel). 2023 Jul 17;11(7):1247. doi: 10.3390/vaccines11071247.
Pregnant women with obesity and diabetes are at increased risk of developing infections and other complications during pregnancy. Several mechanisms are involved in the immunological mechanisms that contribute to reduced immunity in these populations. Both obesity and diabetes are associated with chronic low-grade inflammation that can lead to an overactive immune response. Pregnant women with obesity and diabetes often have an increase in pro-inflammatory cytokines and adipokines, such as TNF-α, IL-6, IL-1β, leptin, and resistin, which are involved in the inflammatory response. Insulin resistance can also affect the functioning of immune cells. Furthermore, both conditions alter the composition of the gut microbiome, which produces a variety of biomolecules, including short-chain fatty acids, lipopolysaccharides, and other metabolites. These substances may contribute to immune dysfunction. In addition to increasing the risk of infections, obesity and diabetes can also affect the efficacy of vaccinations in pregnant women. Pregnant women with obesity and diabetes are at increased risk of developing severe illness and complications from COVID-19, but COVID-19 vaccination may help protect them and their fetuses from infection and its associated risks. Since both obesity and diabetes classify a pregnancy as high risk, it is important to elucidate the impact of these diseases on immunity and vaccination during pregnancy. Research examining the efficacy of the COVID-19 vaccine in a high-risk pregnant population should be of particular value to obstetricians whose patients are hesitant to vaccinate during pregnancy. Further research is needed to better understand these mechanisms and to develop effective interventions to improve immune function in these populations.
肥胖和患有糖尿病的孕妇在孕期发生感染及其他并发症的风险增加。免疫机制中的几个因素导致了这些人群免疫力下降。肥胖和糖尿病都与慢性低度炎症相关，这可能导致免疫反应过度活跃。肥胖和患有糖尿病的孕妇通常促炎细胞因子和脂肪因子增加，如肿瘤坏死因子-α、白细胞介素-6、白细胞介素-1β、瘦素和抵抗素，它们都参与炎症反应。胰岛素抵抗也会影响免疫细胞的功能。此外，这两种情况都会改变肠道微生物群的组成，肠道微生物群会产生多种生物分子，包括短链脂肪酸、脂多糖和其他代谢产物。这些物质可能导致免疫功能障碍。除了增加感染风险外，肥胖和糖尿病还会影响孕妇接种疫苗的效果。肥胖和患有糖尿病的孕妇感染新冠病毒后发生重症和并发症的风险增加，但接种新冠病毒疫苗可能有助于保护她们及其胎儿免受感染及其相关风险。由于肥胖和糖尿病都会使妊娠被归类为高危妊娠，因此阐明这些疾病对孕期免疫和疫苗接种的影响非常重要。研究新冠病毒疫苗在高危孕妇群体中的有效性，对于那些患者在孕期对接种疫苗犹豫不决的产科医生来说应该具有特别的价值。需要进一步研究以更好地理解这些机制，并制定有效的干预措施来改善这些人群的免疫功能。
