Stopping GLP-1RAs before or shortly after conception ups pregnancy complications

Discontinuing treatment with GLP-1RAs before or early into pregnancy in women with obesity may lead to more gestational weight gain and increased risk of preterm delivery, gestational diabetes, and hypertensive disorders of pregnancy, according to a retrospective study.

Researchers identified 149,790 singleton pregnancies delivered between 2016 and 2025 within a single academic health system. They established propensity-score matched cohorts of women with a GLP-1RA order between 3 years before and 90 days after conception (exposed cohort, n=448) and those without such exposure (unexposed cohort, n=1,344).

Gestational weight gain was the primary outcome. Secondary outcomes included excess gestational weight gain, large and small for gestational age birth weight, birth weight percentile for gestational age and sex, birth length, preterm delivery, caesarean delivery, gestational diabetes, and hypertensive disorders of pregnancy.

The exposed cohort had a mean maternal age of 34 years, and 50 percent were non-Hispanic White. The prepregnancy BMI was 36.1 kg/m², 84 percent had obesity, and 23 percent had pre-existing diabetes. Compared with the unexposed cohort, the exposed cohort had greater gestational weight gain (mean, 13.7 vs 10.5 kg; difference, 3.3 kg, 95 percent confidence interval [CI], 2.3–4.2; p<0.001).

The exposed cohort had an elevated risk of excess gestational weight gain (65 percent vs 49 percent; risk ratio [RR], 1.32, 95 percent CI, 1.19–1.47), greater mean birth weight percentile (58.4 percent vs 54.8 percent; difference, 3.6 percent, 95 percent CI, 0.2–6.9), preterm delivery (17 percent vs 13 percent; RR, 1.34, 95 percent CI, 1.06-1.69), gestational diabetes (20 percent vs 15 percent; RR, 1.30, 95 percent CI, 1.01–1.68), and hypertensive disorders of pregnancy (46 percent vs 36 percent; RR, 1.29, 95 percent CI, 1.12–1.49).

Birth length, risk of large or small for gestational age birth weight, and caesarean delivery outcomes were similar between the two cohorts.