Background
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for weight management and glycaemic control in reproductive-aged women. While contraindicated during pregnancy, their growing use before conception raises the risk of inadvertent early fetal exposure, with limited human safety data to guide practice.
Aim
To describe GLP-1RA prescribing patterns in a tertiary maternity cohort and evaluate pregnancy outcomes following inadvertent periconceptional exposure.
Methods
We conducted a retrospective cohort study of women aged 18–50 who were prescribed a GLP-1RA and attended maternity or fertility services at a tertiary hospital between January 2022 and December 2024. Inadvertent exposure was defined as use at conception or within the preceding eight weeks. Maternal characteristics, prescribing patterns, weight loss, and pregnancy outcomes were extracted from electronic medical records.
Results
Among 161 women, semaglutide was the most prescribed agent. Obesity was the most common indication (54.7%), followed by type 2 diabetes (30.4%) and type 1 diabetes (14.9%). Of 48 with weight data, 83% achieved ≥5 kg loss. Eighteen pregnancies met exposure criteria: 7 resulted in live births, 7 in terminations, 1 in miscarriage, 1 ectopic, and 2 were ongoing. One termination followed antenatal diagnosis of tetralogy of Fallot in a woman with pre-existing diabetes. All live births occurred at term, with normal birthweights and APGAR scores; 2 required NICU admission.
Conclusion
This study provides early real-world data on inadvertent GLP-1RA exposure in early pregnancy and underscores the urgent need for prospective safety data to inform reproductive counselling and prescribing decisions.