Two systematic reviews and meta-analyses, one published in Med and one presented at the EASD annual meeting, found no clearly detectable increase in most adverse pregnancy outcomes among women exposed to GLP-1 receptor agonists around conception. The first, covering more than 2.1 million pregnancies, reported no clear rise in miscarriage or intrauterine death, congenital anomalies, preterm birth, hypertensive disorders, gestational diabetes, or abnormal fetal growth. It did show a lower pooled estimate for preeclampsia, but the authors cautioned that this was based on only two datasets.
The second review, focused on over 40,000 women with mostly type 2 diabetes, similarly found no increase in congenital anomaly risk when GLP-1 drugs were stopped in the first trimester. However, it did find a higher rate of early pregnancy loss among exposed women, a result the researchers said is difficult to interpret because the largest contributing study combined miscarriage and termination. The two analyses therefore agree on the absence of a clear congenital anomaly signal but differ on early pregnancy loss.
Both groups stress the findings do not establish safety. The drugs are not approved for use during pregnancy, and labeling recommends stopping them at least two months before planned conception. The authors of the second review issued an international consensus statement calling for continued contraception during GLP-1 use, stopping treatment if pregnancy occurs, and more investment in women's health research.