(720) Anemia in Pregnancy after use of GLP1 for weight management

GLP1 agonist use for weight loss is increasingly common among reproductive age women, though the effects of preconception exposure remain to be determined. Accelerated weight loss can be associated with micronutrient deficiencies. We hypothesize there is a higher prevalence of early pregnancy anemia among those exposed to GLP1 agonists compared to matched controls.

Study Design:

This single-center, multi-site retrospective cohort study included patients receiving prenatal and delivery care between Jan 2022 and Dec 2024 in a large regional health system. Patients with pregestational diabetes, bariatric surgery, hemoglobinopathy, and multifetal pregnancy were excluded, as were those presenting for prenatal care after the first trimester. The exposure group had documented GLP1 use for weight loss in the year prior to pregnancy. The control group was matched 1:2 by baseline pregnancy body mass index (BMI), maternal age, and payor status. Primary outcome was anemia, defined as either hemoglobin < 11 g/dL or hematocrit < 33%, at first trimester prenatal complete blood count. Secondary outcome was anemia at delivery admission. Baseline characteristics and outcomes were compared via chi square or Mann Whitney U test where appropriate. Outcome odds ratios were compared with 95% confidence intervals.

Results:

Among 24,403 pregnancies, 195 GLP1-exposed patients were matched to 330 unexposed controls by age, BMI and payor status. GLP1-exposed patients were more likely nulliparous and have chronic hypertension while controls were more commonly Black (table). At initial assessment, no difference was observed in baseline anemia, with 9.2% of GLP1 patients and 11.8% of controls meeting criteria (aOR 0.80, 95% CI 0.4–1.4, figure). On delivery admission, anemia was observed among 32.7% of GLP1 patients compared to 42.1% of controls (OR 0.70, 95% CI 0.5–1.0).

Conclusion:
In a multi-site cohort, preconception GLP1 agonist exposure was not associated with increased anemia in pregnancy compared with age, BMI and insurer-matched controls.