(103) Assessing Maternal Outcomes in Patients Taking GLP-1 Receptor Agonists Prior to Pregnancy

Maternal comorbidities such as obesity and diabetes increase risk for severe maternal morbidity (SMM). Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising treatment strategy to optimize metabolic health outside of pregnancy. It is unknown whether pre-pregnancy GLP-1 agonist use can optimize maternal pregnancy outcomes. This study evaluates risk of SMM in pregnant patients with obesity by exposure to GLP-1s. 

Study Design:

This retrospective cohort study included patients with pregravid BMI > 30 who delivered at > 20 weeks in a multihospital health system from 1/1/2021-6/30/2025. Patient medications in the EHR were evaluated for 6 months prior to pregnancy to ascertain GLP-1 prescriptions. Maternal demographics and clinical characteristics were extracted from the EHR and compared in bivariate analyses. Multivariable logistic regression was used to assess odds of the primary outcome, SMM without transfusion as defined by the CDC,as well as secondary outcomes (gestational hypertension/mild preeclampsia, severe preeclampsia, ICU admission, 42-day readmission).

Results:

8,669 patients were included: 3.4% were prescribed pre-pregnancy GLP-1 agonists (N = 291). The GLP-1 exposed group were more likely to be older, have higher BMI, and higher obstetric comorbidity index (Table 1). There were no differences in race, ethnicity, or insurance type. Multivariable logistic regression demonstrated aOR of 1.53 (95% CO 0.88 – 2.66) for SMM with pre-pregnancy GLP-1 exposure (Table 2). No differences in secondary outcomes were observed other than for readmission, which was significantly associated with prior GLP-1 use.

Conclusion:
Pre-pregnancy GLP-1 use was not associated with increased risk for SMM or most other adverse maternal outcomes despite higher baseline risk. Optimizing maternal health with novel medications like GLP-1 agonists is an emerging potential strategy to reduce maternal morbidity.