Preconception glucagon-like peptide-1 receptor agonist use associated with decreased risk of adverse obstetrical outcomes

Abstract

Background

The use of glucagon-like peptide-1 receptor agonists has greatly increased in patients of reproductive age within the past 4 years. However, there is limited research on the long-term effects of these medications on future pregnancies.

Objective

This study aimed to evaluate the association between adverse obstetrical outcomes and antecedent glucagon-like peptide-1 receptor agonist use using a nationally representative database.

Study Design

This was a retrospective cohort study of female patients aged ≥18 years using the US Collaborative Network in TriNetX. The exposure cohort was composed of individuals who received a glucagon-like peptide-1 receptor agonist prescription within the 2 years preceding pregnancy. The unexposed cohort was composed of individuals with a history of pregnancy but no previous history of glucagon-like peptide-1 receptor agonist use. The cohorts were matched for age, race, ethnicity, and history of comorbid conditions. The International Classification of Diseases, Tenth Revision, codes for hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and rates of cesarean delivery were the primary outcomes of interest compared between the cohorts. Logistic regression was performed using TriNetX to determine the odds ratios and 95% confidence intervals.

Results

After matching, there were 4267 individuals in each cohort. Compared with individuals who had no prescription for glucagon-like peptide-1 receptor agonist, those who had a prescription for glucagon-like peptide-1 receptor agonist were less likely to develop gestational diabetes mellitus (18.2% vs 15.2%, respectively; odds ratio, 0.81; 95% confidence interval, 0.72–0.91) and hypertensive disorders of pregnancy (22.8% vs 19.9%, respectively; odds ratio, 0.84; 95% confidence interval, 0.76–0.94), experience preterm delivery (4.4% vs 3.0%, respectively; odds ratio, 0.68; 95% confidence interval, 0.54–0.85), and undergo cesarean delivery (19.7% vs 17.6%, respectively; odds ratio, 0.89; 95% confidence interval, 0.87–0.97).

Conclusion

The prescription of glucagon-like peptide-1 receptor agonist within 24 months preceding a pregnancy was associated with a reduced risk of several adverse obstetrical outcomes, including gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and cesarean delivery. This suggests that the use of glucagon-like peptide-1 receptor agonists may be a powerful tool to improve perinatal outcomes in high-risk populations. However, future research is needed to define how this class of medication is best incorporated clinically into preconception health optimization.