Dr Jinwen He1, Dr Adam Morton1
1Mater Hospital, South Brisbane, Australia
Biography:
Jinwen is an obstetric medicine fellow at the Mater Hospital, Brisbane. She completed her MBBS at the University of Queensland, her Masters of Medicine at the University of Sydney, as well as FRACP in endocrinology. Her interests include diabetes management, metabolic disorders and obstetric medicine.
Abstract:
Background: An observational population-based cohort study showed increasing numbers of women are conceiving while taking GLP-1 agonists (1). Current recommendations are to cease semaglutide 2 months prior to conception, due to its long half-life and uncertain safety in pregnancy.(2) In animal studies, maternal exposure to GLP1 agonists have been associated with reduced fetal growth, retardation of ossification and skeletal variants in a dose-dependent fashion.(3) Four individual case reports involving first trimester exposure to GLP1 agonists have not demonstrated teratogenicity in humans.(4-7) An ex-vivo study involving exenatide (8) and an in vivo study involving liraglutide (9) showed negligible placental transfer of these agents. Two multicentre, observational, prospective cohort studies have not suggested maternal exposure to GLP-1 agonists in the first trimester is associated with fetal malformations. (1,10)
Methods: The primary objective of this study was to retrospectively review the outcomes of 13 pregnancies with maternal exposure to semaglutide in the first trimester.
Results: The indication for semaglutide was type 2 diabetes in 12 patients and weight loss in 1 patient. Five women were nulliparous, mean age was 33 years, ten women had BMI>=30kg/m2, and six women had HbA1c>7%. One patient was also exposed to empagliflozin in 1st trimester. One baby had significant cardiac anomalies including tetralogy of Fallot, with the predisposing factors of poor glycaemic control with HbA1c 12.5%, maternal obesity and smoking. There were no other congenital anomalies. Two patients developed pre-eclampsia. One infant had fetal growth restriction in the setting of maternal preeclampsia. Five infants (38%) were delivered prior to 38 weeks gestation, the indications being preeclampsia (2), fetal distress (1), previous stillbirth (1), and marked macrosomia with polyhydramnios (1). Three neonates required treatment for hypoglycaemia.
Discussion: Consistent with current literature, this case series did not demonstrate overt teratogenicity associated with the use of semaglutide.
Keywords
semaglutide, GLP1-agonist, teratogenicity
References
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