GLP-1 receptor agonist exposure in the periconceptional period and adverse obstetric outcomes: A systematic review and meta-analysis.
Francesco D'Antonio, Maria Elena Flacco, Lamberto Manzoli et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined observational studies comparing pregnancies with and without GLP-1 receptor agonist exposure during pregnancy or within six months before a positive pregnancy test. Across ten studies involving 2,118,215 women, pooled estimates showed no clearly detectable increase in miscarriage, intrauterine death, congenital anomalies, preterm birth, hypertensive disorders, gestational diabetes, abnormal fetal growth, or excess gestational weight gain. Preeclampsia had a lower pooled estimate with exposure (OR 0.87, 95% CI 0.78-0.98; p = 0.02), based on two datasets and requiring cautious interpretation.
Key findings
- Ten studies included 2,118,215 women; 8,325 had periconceptional GLP-1 receptor agonist exposure.
- Pooled estimates showed no clearly detectable increase across the reported adverse maternal and perinatal outcomes.
- Preeclampsia had a lower pooled estimate with exposure (OR 0.87, 95% CI 0.78-0.98; p = 0.02), based on two datasets.
Why it matters
These findings help characterise the available evidence on GLP-1 receptor agonist exposure around conception and a broad range of pregnancy outcomes. The absence of a clearly detectable increase is not proof of safety: observational data may be affected by residual confounding, and the evidence base is limited. The preeclampsia estimate is particularly uncertain because it relies on only two datasets.
What to keep in mind
The evidence is observational and subject to heterogeneity and residual confounding. Some outcomes rely on limited datasets; the preeclampsia estimate used two datasets, and the congenital-malformation exposure-window sensitivity analysis reused the same four studies as the primary analysis.