337. Changes in endothelial glycocalyx between the first and third trimester in high-risk and low-risk pregnancies

Abstract

Introduction Pregnancy is associated with several physiological cardiovascular adaptations that begin during early pregnancy and reach a maximum around 30 weeks of gestation. However, little is known about microvascular pregnancy adaptations. The endothelial glycocalyx can be noninvasively visualized using Sidestream Dark Field (SDF) imaging and the Perfused Boundary Region (PBR) reflects its health status, with a high PBR indicating damage. It is possible that the glycocalyx adapts during pregnancy, even in women with known microvascular dysfunction. Objective This study aims to assess changes in endothelial glycocalyx between the first and third trimester of gestation and the differences between high-risk and low-risk pregnancies. Methods A single center prospective cohort study was performed. High-risk pregnancies consisted of pregnant women with suspected microcirculatory endothelial dysfunction, based on pre-specified vascular health complications. Low-risk pregnancies did not show any signs of vascular impairment at the time of measurement. PBR was measured PBR was measured sublingually using the GlycocheckTMat around 12 and 30 weeks of gestation. Results In total, 19 patients were included of which 13 were low-risk and 6 were high-risk. Mean PBR at 12 weeks was 1,83 (±0,25) and 2,05 (±0,27) at 30 weeks (p = 0,041). In low-risk pregnancies PBRs of 1,86 (±0,24) and 2,02 (±0,30) were seen at 12 and 30 weeks, respectively (p = 0,036). For high-risk pregnancies PBR values were 1,79 (±0,27) and 2,12 (±0,19) (p = 0,029). No significance was detected between high-risk and low-risk pregnancies at 30 weeks of gestation. Discussion This research detected a significant change of PBR between the first and third trimesters of pregnancy, indicating microvascular adaptation to pregnancy. This change was visible in both high-risk and low-risk pregnancies, but no substantial difference was observed between both groups at 30 weeks. Further research is needed to determine whether these adaptations are a cause or consequence of cardiovascular adaptations during pregnancy.