(434) Obstetric and Neonatal Outcomes Following Pre-pregnancy Exposure to GLP-1 Receptor Agonists: A Retrospective Cohort Study

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used to manage type 2 diabetes mellitus and promote weight loss in women of reproductive age. While these agents are effective in improving glycemic control and reducing obesity, their safety profile during pregnancy remains uncertain. We aimed to assess whether first-trimester exposure to GLP-1 RAs is associated with adverse obstetric and neonatal outcomes.

Study Design:

This retrospective cohort study included deliveries recorded in the southern district of HMO Services between 2012 and 2024. Women with documented GLP-1 RA exposure during the first trimester were matched 1:3 to unexposed controls using nearest-neighbor matching on maternal age, socio-economic status, gestational age at delivery, calendar year, comorbidity score, and pre-pregnancy BMI. Outcomes included preeclampsia, cesarean delivery, preterm birth, low birth weight, neonatal hypoglycemia, NICU admissions, and a composite maternal morbidity index.

Results:

A total of 636 women were included (159 exposed, 477 unexposed). Baseline characteristics were similar aside from lower diabetes prevalence in the GLP-1 group (47% vs. 100%, p< 0.001). No significant differences were observed in preeclampsia (23% vs. 23%), cesarean delivery (45% vs. 47%, p=0.700), preterm birth, neonatal hypoglycemia, low birth weight, NICU admissions, or composite maternal outcomes.

Conclusion:

Prepregnancy exposure to GLP-1 RAs was not associated with increased risk of adverse obstetric or neonatal outcomes. These findings support the safety of inadvertent exposure and underscore the need for additional long-term studies.