GLP-1 Receptor Agonists and Other Pharmacotherapy for Type 2 Diabetes and Obesity: Use and Safety in Pregnancy

Semaglutide and other GLP-1 receptor agonists (GLP-1 RA) have revolutionized the treatment of type 2 diabetes and obesity and their use in Sweden and globally has increased dramatically since 2020. Women are more likely to be overweight or obese which is associated with infertility and adverse pregnancy outcomes.

GLP-1 RA may be an effective tool to lose weight before pregnancy and while it is advised that they are discontinued two months prior to conception, up to 50% of pregnancies are unplanned.

Unintended GLP-1 RA exposure in early pregnancy is a real possibility and it is unknown if they increase the risk of malformations in infants.

Additionally, even if GLP-1 RA are discontinued as recommended, there is a chance of excessive weight gain in pregnancy which is associated with adverse pregnancy outcomes, such as gestational diabetes.This project aims to fill this knowledge gap through observational studies using a common protocol in data from Swedish population health registers and from other Nordic and international collaborators.

First, utilization patterns and characteristics of women using GLP-1 RA will be described.

Then the risk for adverse pregnancy outcomes will be compared between exposed and unexposed pregnancies from women with similar body mass index. High quality evidence will be generated in a timely manner to help avoid unnecessary harm. Results may also provide reassurance to those who can benefit from these new pharmacotherapies.