ORLANDO, Florida — New research presented at the American Diabetes Association’s 84th Scientific Sessions underscores concerns regarding weight gain when discontinuing glucagon peptide-1 receptor agonists (GLP-1 RAs) prior to pregnancy. According to findings from a retrospective cohort study conducted by Dr. Camille E. Powe and colleagues, women who discontinue these drugs before pregnancy experience significantly greater weight gain during pregnancy compared to those who were not exposed to GLP-1 RAs.
Dr. Powe, senior author and associate professor of Obstetrics, Gynecology, and Reproductive Biology at Massachusetts General Hospital, emphasized the implications: “Many individuals exceed the recommended gestational weight gain guidelines if they discontinue these medications before pregnancy.”
The study, which included 188 singleton pregnancies from 2016 to 2022 among women with preexisting type 2 diabetes, employed propensity score matching to compare outcomes between women with and without prior GLP-1 RA use. Factors matched included prepregnancy BMI, maternal age, gestational age at delivery, race and ethnicity, and health insurance status.
Among the findings, women with prior GLP-1 RA exposure had a mean gestational weight gain of 24.9 lb compared to 19.1 lb in the unexposed group (P = .03). Furthermore, 61.7% of the GLP-1 RA-exposed group exceeded recommended weight gain compared to 41.1% in the unexposed group (P = .02).
The implications of excessive weight gain in pregnancy are substantial, according to Dr. Powe. Risks include gestational diabetes, macrosomia, cesarean delivery, and hypertensive disorders of pregnancy, all of which pose risks to both mother and child.
Dr. Maisa N. Feghali, assistant professor at the University of Pittsburgh, highlighted additional concerns regarding the timing of discontinuation of GLP-1 RAs: “Taking action to discontinue these drugs just before conception can lead to rapid weight gain during early pregnancy, which is a significant risk in itself.”
Dr. Feghali emphasized the challenges of managing weight gain and pregnancy risks among women with preexisting conditions, noting the uncertainty surrounding the use of GLP-1 RAs during pregnancy. Studies in animals have suggested potential adverse effects, although definitive risks in humans remain unclear.
Despite recommendations against GLP-1 RA use during pregnancy, inadvertent exposures may occur due to unplanned pregnancies and the drugs’ potential impact on fertility. Dr. Feghali highlighted the need for early prenatal care to mitigate risks associated with unintentional fetal exposures.
In conclusion, the discussion surrounding GLP-1 RA use in pregnancy underscores the importance of informed patient counseling and careful management to minimize risks associated with weight gain and medication exposures during gestation.
