Biomarkers of endothelial glycocalyx dysfunction in pregnancy: a systematic review of clinical relevance and detection techniques

Objective and design: 

The endothelial glycocalyx (EG) is a key regulator of vascular homeostasis, acting as a dynamic barrier between the bloodstream and the endothelium. In pregnancy, structural and functional alterations of the EG have been increasingly implicated in the pathogenesis of endothelial dysfunction, particularly in preeclampsia and other vascular complications. This systematic review critically examines current evidence on circulating biomarkers of EG degradation and their clinical relevance in hypertensive and metabolic disorders of pregnancy. 

Methods:

We explore the mechanistic role of the glycocalyx in maintaining vascular integrity, evaluate state-of-the-art detection methods—including sidestream dark field (SDF) imaging and biochemical assays—and summarize data on key circulating components such as syndecan-1, hyaluronic acid, heparan sulfate, and adhesion molecules. 

Results: 

Particular attention is given to distinguishing early- from late-onset preeclampsia and to other high-risk obstetric conditions, including gestational diabetes, fetal growth restriction, and infection-related complications. Despite heterogeneity across studies, most findings support a consistent association between EG disruption and adverse maternal–fetal outcomes. 

Conclusions: 

This review highlights the potential of glycocalyx-derived biomarkers and imaging tools as non-invasive indicators of microvascular injury. Their integration into existing surveillance models could enhance early risk stratification and open new avenues for targeted clinical interventions in cardio-obstetric care.