GLP-1 Exposure Around Pregnancy: No Clear Rise in Adverse Outcomes

AMONG MORE THAN 2.1 million pregnancies, exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) around conception has not been linked to a clearly detectable rise in adverse outcomes, according to a new meta-analysis of GLP-1 pregnancy data.

GLP-1 Safety Data in Pregnancy

GLP-1 RAs are used to treat diabetes and obesity, including by people who may become pregnant. These medicines are not recommended during pregnancy and safety data remain limited, so outcomes after accidental exposure around conception are important to understand.

Search Strategy and Study Population

Researchers searched Medline, Embase, and the Cochrane Library for observational studies comparing pregnancies exposed and unexposed to GLP-1 RAs within 6 months before a positive pregnancy test.

Outcomes included miscarriage, intrauterine death, congenital anomalies, preterm birth, hypertensive disorders of pregnancy, gestational diabetes mellitus, fetal growth restriction, small for gestational age, large for gestational age and excess gestational weight gain.

Ten studies were included, comprising 2,118,215 women, of whom 8,325 were exposed and 2,109,890 were unexposed.

Pooled Obstetric Outcome Estimates

Pooled estimates showed no clearly detectable increase in miscarriage or intrauterine death, congenital anomalies, preterm birth, hypertensive disorders of pregnancy, gestational diabetes, abnormal fetal growth or excess gestational weight gain.

A lower pooled estimate for preeclampsia was observed (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.78 to 0.98; P=0.02), but this was based on two datasets. Subgroup analyses showed no clearly detectable differences by indication.

The exposure-window sensitivity analysis, covering 90 days before conception through the end of the first trimester, used the same four studies as the primary congenital malformation analysis and left findings unchanged, although it was not independent.

Interpretation and Research Priorities

These findings may offer limited reassurance after inadvertent exposure to GLP-1 RAs in early pregnancy, but they do not establish safety or support continued use during pregnancy because of heterogeneity, residual confounding and limited datasets. The lower preeclampsia estimate requires confirmation, and larger studies with consistent exposure definitions are needed.

Reference

D’Antonio F et al. GLP-1 receptor agonist exposure in the periconceptional period and adverse obstetric outcomes: A systematic review and meta-analysis. Med. 2026;DOI:10.1016/j.medj.2026.101267.

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