GLP-1 RA Use in Pregnancy: Systematic Review and Meta-Analysis of Adverse Outcomes

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RetCurious

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A Systematic Review and Meta-Analysis of Adverse Pregnancy Outcomes

What clinical question does this address?

Among pregnant individuals, how does exposure to GLP-1 RA compare with other antidiabetic therapies in terms of maternal or fetal outcomes?

What is the key finding?

With GLP-1 RA exposure, maternal outcomes and preterm birth outcomes were better, and there was no significant rise in congenital malformations or overall adverse fetal outcomes.


https://www.jacc.org/doi/10.1016/j.jacadv.2026.102649
 
The brief response is to discontinue them a few months prior to conceiving, as is the case with most medications when possible, since their safety profile hasn't been established yet. This marks the beginning of figuring out whether they are safe or not, but it probably won't be settled for a long time because no ethics committee is going to greenlight a trial, so answers will come from the results of many unintentional exposures over years. So far there are no alarming signals, and findings such as these indicate that early pregnancy exposure is unlikely to be a problem, though it would certainly be something requiring expert advice if you were to conceive while taking them, and nobody is going to suggest remaining on them during pregnancy until there is far better data. Considering how many ozempic babies there are, early pregnancy safety will probably be determined much sooner.
 
It caught me off guard to learn that neonatal units even prohibit BAC water.

On the topic of pregnancy:




Bacteriostatic Water Injection



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In practice, using bacteriostatic water as a diluent for a single-dose medication in a nursing mother is unlikely to pose significant risk, but caution is still advised. If repeated injections (containing bacteriostatic water) are required in a breastfeeding mother, healthcare providers will consider the potential accumulation of benzyl alcohol.

As with pregnancy, an alternative preservative-free diluent may be preferred for nursing mothers if feasible.

Ultimately, decisions on using bacteriostatic water during pregnancy or lactation should involve a risk-benefit assessment by the physician, and therapy should be monitored closely.

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lessthanhalf said:

The brief response is to discontinue them a few months prior to conceiving, as is the case with most medications when possible, since their safety profile hasn't been established yet. This marks the beginning of figuring out whether they are safe or not, but it probably won't be settled for a long time because no ethics committee is going to greenlight a trial, so answers will come from the results of many unintentional exposures over years. So far there are no alarming signals, and findings such as these indicate that early pregnancy exposure is unlikely to be a problem, though it would certainly be something requiring expert advice if you were to conceive while taking them, and nobody is going to suggest remaining on them during pregnancy until there is far better data. Considering how many ozempic babies there are, early pregnancy safety will probably be determined much sooner.
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Right after I found out I was pregnant, a study reached out to me. They were researching Ozempic use during pregnancy. Before I got pregnant, I had been taking mounjaro for 10 months. We decided to try for a baby, figuring it would take a while, but I conceived within a few weeks of stopping, so studies on this definitely exist. Since women with diabetes still need to continue their diabetes medication while pregnant, it makes sense that they would be investigating this as well. When they contacted me, it was around August or September 2023.
 
My understanding is that EL keeps a place to report pregnancy exposures, so observational data ought to surface in time.
 
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