Miss Shikofa Azizullah1,2, Dr Nayomi Perera1,2,3, Dr Sarah Price1,2,3
1Department of Medicine, University of Melbourne, Melbourne, Australia, 2Department of Obstetric Medicine, Royal Women’s Hospital, Melbourne, Australia, 3Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
Biography:
Biographies to come
Abstract:
Background: Effective management of type 2 diabetes and obesity is crucial for women of reproductive age due to its significant impact on fertility and pregnancy outcomes. Incretin analogues, widely used for these conditions, are increasingly prescribed to women of reproductive age because of their efficacy in metabolic control. Despite their classification as Therapeutic Goods Administration (TGA) pregnancy category D drugs —indicating potential risks of fetal malformations based on animal studies —their use remains prevalent. This review aims to systematically evaluate the existing literature on the safety of GLP-1 receptor agonists in women planning pregnancy.
Methods: A comprehensive search of the Ovid, Medline Web of Science, and Cochrane database of systemic reviews identified 59 relevant articles. Studies focusing solely on animal data or not directly addressing pregnancy outcomes were excluded. The remaining 7 studies were critically appraised to assess the safety and efficacy of incretin analogues in the context of pregnancy planning.
Results: Most studies indicated no significant increase in major congenital malformations with incretin analogues compared to insulin, the standard treatment for glycaemic control in pregnancy. Additionally, there were no reported adverse pregnancy or neonatal outcomes associated with these drugs in the reviewed studies.
Conclusions: Preliminary human studies suggest that incretin analogues may not pose substantial risks to pregnancy outcomes. However, the limited data available leave critical gaps in knowledge, particularly regarding the optimal timing for discontinuation before conception. Further investigation is essential to develop clear safety guidelines for the use of incretin analogues in women planning pregnancy.
Keywords
Incretin analogues, GLP-1 receptor agonists, pregnancy, diabetes, obesity, metabolic control, fertility.
References
Dao K, Shechtman S, Weber-Schoendorfer C, et al. Use of GLP1 receptor agonists in early pregnancy and reproductive safety: a multicentre, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ Open. Apr 24 2024;14(4):e083550. doi:10.1136/bmjopen-2023-083550
Cesta CE, Rotem R, Bateman BT, et al. Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy. JAMA Intern Med. Feb 01 2024;184(2):144-152. doi:10.1001/jamainternmed.2023.6663
Therapeutic Goods Administration (TGA). (2024). Prescribing medicines in pregnancy database. Australian Government Department of Health. Retrieved from https://www.tga.gov.au/prescribing-medicines-pregnancy-database