GLP-1 Use in Early Pregnancy Linked to Lower Chance of Below-Recommended Weight Gain, Study Finds

WASHINGTON — Taking GLP-1 receptor agonist medications for weight loss during early pregnancy was linked to a lower risk of gaining too little weight during pregnancy, according to a new study presented at the American College of Obstetricians and Gynecologists annual meeting.

The research, a retrospective cohort study, looked at how these popular weight-loss and diabetes drugs affect pregnancy outcomes. Nishita Pondugula, MD, MS, a first-year resident at Duke University Medical Center in Durham, North Carolina, reported that women who used GLP-1 drugs for weight management in early pregnancy had significantly lower odds of gaining weight below the levels recommended by the Institute of Medicine (IOM). The adjusted odds ratio was 0.29, with a 95% confidence interval of 0.12 to 0.70, meaning these women were about 71% less likely to have insufficient weight gain.

However, the study found that using GLP-1 medications only before pregnancy—without continuing into early pregnancy—did not significantly affect gestational weight gain. Pondugula suggested this could indicate a “slowing of rebound weight gain after more time has passed since GLP-1 cessation.” She also noted that there were no major differences when it came to exceeding IOM weight gain recommendations. It is common for people to regain weight after stopping GLP-1 drugs.

The researchers also examined whether GLP-1 use up to one year before pregnancy affected the risk of developing hypertensive disorders of pregnancy, such as preeclampsia or gestational hypertension. For women taking the drugs for pregestational diabetes, the adjusted odds ratio was 0.72 (95% CI 0.42-1.25), and for those using them for weight management, it was 0.83 (95% CI 0.45-1.52). Neither result was statistically significant, meaning the study did not find a clear link between GLP-1 exposure and these pregnancy complications.

Pondugula pointed out a possible signal for risk of fetal death in the weight-management group, with 2.9% of exposed pregnancies ending in fetal death compared to 0.5% in the control group. However, this difference did not reach statistical significance, meaning it could be due to chance. This signal was not seen in the diabetes group. Some animal studies have raised concerns about fetal death with GLP-1 medications, but observational studies in humans have not shown an increased risk.

There is very limited evidence on how GLP-1 drugs affect women before and during early pregnancy, but more and more patients are using them for both diabetes and weight loss. Earlier research, which mainly included women with obesity, suggested that stopping GLP-1 medications as recommended during pregnancy was linked to more weight gain and higher risks of pregnancy complications. Another small study found that using GLP-1 drugs before pregnancy was tied to a lower risk of gestational diabetes, but not preeclampsia.

Dr. Nikki Zite, an ob/gyn at the University of Tennessee Graduate School of Medicine in Knoxville who was not involved in the study, said that with the growing use of these medications, especially among women of reproductive age, it is crucial to keep studying their potential risks and benefits to offer evidence-based guidance. She told MedPage Today that she was not surprised that fewer patients in the study gained less than the recommended weight, given the weight gain that often happens when people stop GLP-1 drugs combined with typical pregnancy weight gain.

Although the researchers did not find a significant link between the medications and hypertensive disorders of pregnancy, Zite noted that “given the biologic plausibility and the non-significant risk reduction they noted, further investigation is warranted.”

The study aimed to evaluate how GLP-1 receptor agonist exposure up to one year before pregnancy affects gestational weight gain and the development of hypertensive disorders, for women using the drugs for either weight management or diabetes.

Pondugula and her team reviewed electronic medical records for all deliveries at the Yale New Haven Health system between 2014 and 2024. They manually confirmed GLP-1 drug exposure and usage dates up to one year before pregnancy. In total, 243 people had been exposed to GLP-1 medications. The researchers included 103 patients who used the drugs for diabetes along with a control group of 175 patients, and 140 patients who used them for weight management along with a control group of 200 patients.

Semaglutide (sold as Ozempic and Wegovy) was the most commonly used GLP-1 drug, accounting for 63% of cases. On average, the last use of a GLP-1 medication was 14 days before pregnancy. For those who used the drugs only before pregnancy, the average time since last use was 142 days before pregnancy. For those exposed during early pregnancy, the last use was around 53 days into pregnancy.

The main outcome measured was maternal gestational weight gain, adjusted based on weekly IOM recommendations and accounting for how far along the pregnancy was at delivery. The co-primary outcome was a diagnosis of a hypertensive disorder of pregnancy, which includes gestational hypertension, preeclampsia (with or without severe features), superimposed preeclampsia, eclampsia, and HELLP syndrome (a serious condition involving hemolysis, elevated liver enzymes, and low platelet count).

In the group with pregestational diabetes, Black patients were significantly more likely to have been exposed to GLP-1 drugs, as were those with a prepregnancy body mass index (BMI) of 30 or higher. The control group in this cohort was significantly more likely to be using metformin. In the weight-management group, those exposed to GLP-1 drugs were significantly more likely to have chronic hypertension or polycystic ovary syndrome, and significantly less likely to have a prepregnancy BMI of 30 or higher.

Pondugula said future research should focus on finding the best timing for stopping GLP-1 receptor agonists around pregnancy and on understanding the safety of continuing these medications during pregnancy, especially for women using them to manage pregestational diabetes.

Source: MedPage Today