(999) Association between Preconception GLP-1 Use in Patients without Diabetes and Risk of Gestational Diabetes

Glucagon-like peptide-1 (GLP-1) receptor agonists are a novel treatment for obesity and may be used by reproductive age patients. This study evaluates the association between GLP-1 agonist use in patients without diabetes prior to pregnancy and risk of gestational diabetes (GDM).

Study Design:

This is a retrospective cohort study of patients delivering in a large health system from 1/1/2021-6/30/2025 with BMI >30. All deliveries at > 20 weeks in patients without a diagnosis of pre-gestational diabetes were included. Patient demographic and clinical characteristics, including prescriptions for the 6 months preceding pregnancy, were extracted from the EHR and compared in bivariable analyses. The primary exposure was a prescription for a GLP-1 receptor agonist in the 6 months prior to pregnancy. The association of preconception GLP-1 use with the primary outcome (incidence of GDM) and secondary outcomes (GDM requiring insulin, cesarean delivery, and shoulder dystocia) was assessed with multivariable logistic regression.

Results:

8213 patients were included, 208 of which were prescribed GLP-1 receptor agonists prior to pregnancy (2.5%). Patients prescribed GLP-1 receptor agonists tended to be older and have higher pregravid and delivery BMIs as well as higher rates of bariatric surgery and chronic hypertension [Table 1]. They also had earlier presentation to prenatal care. Adjusted analysis demonstrated no significant association between GDM and GLP-1 use, though GDM requiring insulin was marginally associated (aOR 1.32, 95% CI 0.93-1.89; aOR 1.52, 95% CI 1.01-2.38, respectively) [Table 2]. There were no significant differences in the other secondary outcomes.

Conclusion:

Despite higher prevalence of risk factors for GDM such as higher BMI and older age in patients prescribed GLP-1 receptor agonists, odds of GDM were not increased. This may suggest a protective effect of pre-pregnancy GLP-1 receptor agonist use which requires further detailed study to elucidate opportunities to optimize pregnancy outcomes for patients with obesity.