GLP-1 Discontinuation Pregnancy Risks Highlighted
- 6 days ago
- 2 min read
A new wave of research is raising urgent questions about the safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs)—medications often prescribed for Type 2 diabetes and increasingly used off-label for weight loss—for women planning pregnancy. Current medical guidelines advise against using these drugs during pregnancy and recommend that women of reproductive age utilize effective contraception while on them, due to unclear safety profiles and animal studies suggesting potential risks like fetal growth restriction.
However, recent studies reveal a significant dilemma: while GLP-1 discontinuation is recommended prior to conception, stopping the medication may introduce its own set of hazards for the mother.
National data from Australia indicates a sharp rise in GLP-1 prescriptions for young women. This increase has coincided with the approval and PBS listing of semaglutide in Australia since 2020. The majority of prescriptions are for non-diabetes indications, suggesting widespread off-label use for weight loss.
Critically, the data show a wide gap in compliance with safety recommendations. More than 75% of women prescribed GLP-1 RAs do not use contraceptives when initiating these agents. This low contraception use leaves many at risk of unintended pregnancy and uncertain outcomes for their babies, especially since 40% of pregnancies in Australia are unplanned. Across the cohort studied (10,781 women followed for at least six months), 232 pregnancies occurred within six months of being prescribed these agents.
Women who were on contraception when they started GLP-1 RAs were 40% less likely to conceive in the following six months.
For women who follow the advice to discontinue GLP-1 RAs prior to conception, new US research suggests this cessation may pose risks.
Researchers tracked almost 1,800 pregnancies, focusing on women who had stopped GLP-1 treatment up to 90 days after conception. The majority of these pregnancies occurred among women with obesity.
The comparison found that women who discontinued the drugs had an average gestational weight gain that was 7.2 pounds higher than those who had never used GLP-1s. About 65% of the GLP-treated group experienced "excessive gestational weight gain," compared with 49% of the comparison group.
Furthermore, stopping GLP-1s was associated with several adverse maternal outcomes, including:
30% higher risk of developing gestational diabetes.
29% higher risk of blood pressure issues during pregnancy (hypertensive disorders).
34% higher risk for preterm delivery.
The study noted that these findings only show associations and cannot prove that GLP-1 discontinuation caused the excess risks. Still, the results present women with obesity with a quandary regarding whether to use a GLP-1 before pregnancy.
Study authors emphasize that more research is urgently needed to generate evidence that can inform obstetric care and guide treatment initiation decisions, particularly concerning how to manage weight gain and reduce risks when stopping GLP-1 medications for conception. The current data serve as a "heads up" for doctors to monitor these patients closely.
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Keywords: GLP-1
GLP-1
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