(803) Risk of Hypertensive Disorders of Pregnancy with Pre-Pregnancy GLP-1 Agonist Exposure

Use of glucagon-like-peptide-1 (GLP1) agonists has dramatically increased, with 12% of US adults reporting use in 2024, including half for weight loss indications alone. Limited data exists on pre-pregnancy GLP1 use with pregnancy outcomes. We aim to evaluate the association between preconception GLP1 use and subsequent pregnancy-associated hypertension (PAH).

Study Design:
We performed a retrospective cohort study of those receiving prenatal and delivery care in a large regional health system from 2022-2024. We included pregnancies with establishment of prenatal care before 20 weeks gestation that delivered after 20 weeks. Documented pregestational diabetes, prior bariatric surgery, and multifetal pregnancies were excluded. Baseline characteristics and comorbidities such as chronic hypertension (CHTN) were extracted from the electronic medical record. Recorded GLP1 use in the year prior to pregnancy defined exposure; controls had no documented use. Primary outcome was diagnosis of gestational hypertension or preeclampsia. Regression analyses controlling for age, BMI, and CHTN generated adjusted odds ratios with 95% confidence intervals.

Results:

Of 24,403 eligible pregnancies, 165 (0.7%) were exposed to GLP1 agonists in the twelve months prior to pregnancy while 24,238 (99.3%) were classified as controls. As expected, the GLP1 group had higher baseline BMI. The GLP1 group likewise had higher age and nulliparity. Controls were more likely to be Black and use Medicaid insurance (Table 1). CHTN was more prevalent in the GLP1 group (13% vs 3%, p < 0.0001). PAH occurred in 31.5% of the GLP1 agonist group compared to 17.4% among controls, a difference which persisted even when controlling for age, BMI and CHTN (aOR 1.9, 95% CI 1.4-2.7, Figure 1). No difference was observed in PAH with severe features among GLP1 exposed (4.9%) vs controls (4.1%, aOR 1.3, 95% CI 0.6, 2.5).

Conclusion:

Preconception GLP1 agonist use was associated with increased PAH even when controlling for well-established risk factors associated.