Obstetrical and medical outcomes following GLP-1 receptor agonist exposure in pregnancy: a case series

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has increased over the past several years. The resulting improved blood sugar control and optimized body weight ultimately improve fertility. Thus, it is increasingly common to have individuals inadvertently becoming pregnant while using GLP-1 RAs. This case series describes outcomes following the inadvertent use of GLP-1 RAs in the first trimester of pregnancy, including the incidence of major malformations, maternal glucose control and gestational weight gain. This case series included individuals receiving obstetric care at a tertiary perinatal center who had exposure to a GLP-1 RA between 2 months preconception to pregnancy conclusion for any indication or duration. Electronic medical records of participants were reviewed for fetal, obstetrical, maternal, and neonatal outcomes. There were 16 patients in the series. All had spontaneous and unplanned conception of singleton pregnancies while using subcutaneous semaglutide and continued administration during a part of the first trimester. All included patients were overweight or obese. No individual lost weight in pregnancy. No major fetal anomalies were identified. Following discontinuation of semaglutide, diabetes control required both metformin and insulin for most patients. There was one instance of iatrogenic preterm birth at 35 weeks for preeclampsia. The rate of preeclampsia was 18.8%. Given the high rate of obesity, there was a lower-than-expected rate of excessive gestational weight gain (37.5%). Further studies on the safety and possible benefits of GLP-1 RAs in pregnancy are required.