(640) U.S. state-level periconception GLP-1 receptor agonist prescription prevalence in 2023 and 2024

Glucagon-like peptide 1 receptor agonist (GLP-1RA) use in the U.S. is increasing. The impact on exposure risk during pregnancy is uncharacterized. We sought to examine recent state-level prevalence and changes in periconception GLP-1RA prescriptions. 

Study Design:

This was a retrospective cohort study using the Epic Cosmos platform, a nationwide database of individuals receiving care at sites that use the Epic electronic health record. Inclusion criteria were births at > 20 weeks in 2023 and 2024. Periconceptional GLP-1RA prescriptions, ordered from 120 days before or after estimated conception, were identified. The prevalence of a GLP-1RA prescription by state was calculated, as was the relative change in prevalence from 2023 to 2024. The number of births recorded in Cosmos was compared to U.S. natality records to determine the state sampling rate. The national prescription rate was estimated by calculating a weighted average of state-level exposure rates, accounting for both the number of births in each state and sampling coverage.

Results:

Of the ~7.2 million U.S. births during the study, Cosmos reported ~2.2 million (31.1%). Sampling rates varied by state (mean 31.2%, standard deviation 15.0%). In total, 15,025 (0.65%) had a periconception GLP-1RA prescription. The national weighted average was 0.67%. Prescription rates varied geographically (Figure 1), as did the rate of change from 2023 to 2024 (Figure 2). Indiana, Kansas, West Virginia, and Kentucky had the highest prevalence (1.02-1.41%). Only one state (Delaware) reported a lower prescription rate in 2024 than in 2023. Tennessee, Pennsylvania, Arkansas, Missouri, Louisiana, Maryland, and South Dakota all had more than 2.5-fold increases in prevalence. 

Conclusion:

Periconception GLP-1RA prescriptions are becoming more common, with variation at the state level. This study provides estimates potential population-level exposure risk at the local level that may inform approach to preconception counseling. Further study is needed to understand drivers of state-level variability.