Glucagon-Like Peptide-1 Receptor Agonists Use Among Reproductive-Aged Women with Type 2 Diabetes

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer important cardiovascular-kidney-metabolic benefits to women with type 2 diabetes (T2D) but are contraindicated during pregnancy. We sought to describe the frequency of GLP-1 RA prescribing among young women with T2D and to examine pregnancy intention, contraceptive use, and receipt of reproductive health counseling in this population.

A total of 382 English- and Spanish-speaking women with T2D, aged 18-44, were recruited from 38 health centers in Chicago. Patients were enrolled in the usual care arm of an ongoing clinical trial testing a preconception health intervention. GLP-1 RA prescribing was determined via self-report with chart verification. Bilingual research coordinators administered structured surveys measuring pregnancy intention, contraceptive use, and receipt of reproductive health counseling.

Participants were sociodemographically diverse; 42.5% had a household income less than $35,000/year, 46% had limited health literacy, and the average age was 36 years. Half (50.8%) were prescribed a GLP-1 RA. Among women prescribed GLP-1 RAs (n = 194), 54.6% intended a future pregnancy; 40.7% used hormonal contraceptives or an intrauterine device. Few reported discussing pregnancy intention (11.9%), contraceptive use (11.4%), or preconception health (13.4%) during their recent visit. Women with limited health literacy were less likely to report discussing preconception health (6.3%, 95% confidence interval [CI]: 1.4-11.2 versus 18.4%, 95% CI: 12.0-24.9, p = 0.01).

GLP-1 RAs are commonly prescribed to young women with T2D, many of whom intend a future pregnancy, yet reproductive health counseling is scarce. Optimizing preconception care is critical to improve outcomes, particularly for women with limited health literacy.