What is known about the use of weight loss medication in women with overweight/obesity on fertility and reproductive health outcomes? A scoping review

Pregnancy during or soon after treatment with weight loss medication, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), is contraindicated due to potential teratogenicity. The aim of this scoping review is to investigate what is known about the use of weight loss medication in women of childbearing age in relation to reproductive health outcomes, focusing on the three medications licenced in the United Kingdom at the time of the search. A systematic search of studies that assessed reproductive health outcomes in women taking either orlistat, liraglutide or semaglutide was undertaken in July 2023 and updated in January 2024 across MEDLINE, Embase, CINAHL, Scopus, ClinicalTrials.gov, PROSPERO, Epistemonikos and OpenGrey. Studies focused on polycystic ovarian syndrome, diabetes or animals were excluded. Titles and abstracts were screened, and data from included articles were extracted. After removal of duplicates, 341 titles remained, of which 318 were excluded. Of the final 18 articles included, there were five interventional trials, one retrospective case-control study, six narrative reviews, two systematic reviews, three systematic review protocols and one registry protocol yet to start recruitment. All five interventional trials involved orlistat given preconceptionally, showing no improvement in live birth rate, despite improvement in reproductive hormone levels. There were no studies with primary data about GLP-1 RAs. There were no qualitative studies. There is an absence of primary data about the role of GLP-1 RAs on the reproductive health of women of childbearing age without polycystic ovarian syndrome. Future research should explore short- and long-term effects on reproductive health, pregnancy outcomes and experiences.