CTSS and gestational diabetes: Other studies have revealed the impact of GDM on amniotic mesenchymal stem cells that showed up-regulated expression of genes involved in the inflammatory responses (TNFα, CTSS, CD40, and MCP-1) and the down-regulated IL-33 anti-inflammatory cytokine [13], and on the chorionic MSCs-GDM that showed significantly increased adipogenic differentiation ability [14].