Cervical Glycosaminoglycans and Extracellular Matrix Remodeling: New Insights and the Therapeutic Promise of Tafoxiparin

Cervical ripening is a multifaceted process involving endocrine, inflammatory, and biomechanical signals that act on the cervical extracellular matrix. While previous reviews have focused on hormonal and immune mechanisms, the specific role of cervical glycosaminoglycans (GAGs)-particularly hyaluronan and heparan sulfate-has received limited dedicated attention. This review addresses that gap by exploring how these GAGs function as integrators of hormonal cues, immune activation, and extracellular matrix remodeling during pregnancy and labour. We conducted a narrative synthesis of experimental, translational, and clinical studies on GAG composition, metabolism, and signaling, with particular attention to tafoxiparin, a heparan-sulfate-based compound with minimal anticoagulant activity. Available evidence suggests that alterations in hyaluronan and heparan sulfate content influence collagen disorganization, tissue hydration, immune cell infiltration, and prostaglandin production-collectively contributing to cervical softening and dilatation. Although tafoxiparin may replicate some actions of endogenous GAGs, current clinical data remain sparse and inconclusive. Thus, targeting cervical GAG biology represents a mechanistic yet still investigational strategy, requiring further studies to determine its therapeutic value.