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Periconceptional GLP-1 receptor agonist exposure and obstetric outcomes: a Danish nationwide cohort study

Kathrine Vauvert R Hviid1,2, Karina Banasik1,3, Laust Hvas Mortensen4,5,6

  • 1Department of Gynecology and Obstetrics, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.

Human Reproduction Open
|March 19, 2026
PubMed

Insights

Periconceptional GLP-1 receptor agonist use for diabetes, not weight management, was linked to higher preterm birth risk. This suggests diabetes itself, rather than the medication, may be the cause.

Area of Science:

  • Reproductive Endocrinology and Obstetrics
  • Pharmacology and Therapeutics
  • Public Health and Epidemiology

Background:

  • Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly used by women of reproductive age for diabetes and obesity.
  • While not approved for pregnancy, inadvertent periconceptional exposure is common, with limited data on obstetric outcomes.
  • Existing research shows no increased risk of major congenital malformations but lacks comprehensive obstetric data.

Purpose of the Study:

  • To investigate the association between periconceptional GLP-1 receptor agonist exposure and the risk of obstetric complications.
  • To differentiate risks associated with GLP-1 receptor agonist use for diabetes versus weight management.

Main Methods:

  • Nationwide observational cohort study using Danish health registries (October 2009-December 2023).
  • Analysis of 756,636 singleton pregnancies, with 529 exposed to periconceptional GLP-1 receptor agonists (liraglutide or semaglutide).
  • Propensity score matching was used to compare exposed pregnancies with unexposed controls, adjusting for multiple covariates.

Main Results:

  • After propensity score matching, only preterm birth risk remained significantly elevated in women exposed to GLP-1 receptor agonists.
  • This increased preterm birth risk was confined to women using these medications for pre-existing diabetes treatment.
  • No association with preterm birth was observed in women without pre-existing diabetes using GLP-1 receptor agonists for weight management.

Conclusions:

  • Periconceptional GLP-1 receptor agonist exposure for diabetes treatment is associated with an increased risk of preterm birth.
  • The findings suggest that underlying diabetes, rather than the GLP-1 receptor agonist itself, may be the causal factor for preterm birth.
  • Results have implications for preconception counseling and may inform future guidelines for GLP-1 receptor agonist use in reproductive-age women.
Abstract

Keywords:
GLP-1 receptor agonistdiabetesliraglutideobesitypericonceptional exposurepregnancypreterm birthsemaglutide

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