Periconceptional exposure to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) did not increase the risk of adverse pregnancy outcomes in women with pregestational type 2 diabetes mellitus (T2DM). A study published in Diabetes, Obesity and Metabolism assessed safety signals associated with GLP-1 RA use around conception in a national cohort.

Records from Taiwan’s Birth Certificate Application and National Health Insurance claims were linked from 2013 to 2022. The study included singleton births to women aged 18 to 50 years with T2DM. Exposure was defined as any GLP-1 RA dispensed within 90 days before or after the last menstrual period. Insulin-treated pregnancies without GLP-1 RA served as the comparator. Propensity-score matching (1:4 ratio) and Poisson generalized estimating equation models evaluated risks for major congenital malformations, stillbirth, preterm birth (<37 weeks), and small-for-gestational-age status.

Among 3351 eligible pregnancies, 160 had GLP-1 RA exposure and 3191 received insulin; matching yielded 160 vs 606 pregnancies. Risk ratios for GLP-1 RA versus insulin were: malformations 0.64 (95% confidence interval [CI] 0.11–3.83), stillbirth 2.05 (95% CI 0.82–5.13), preterm birth 1.09 (95% CI 0.85–1.39), and small-for-gestational-age 0.86 (95% CI 0.31–2.41). Sensitivity analyses requiring ≥2 prescriptions or limiting exposure to the first trimester produced similar estimates.

These results provide early reassurance regarding unintentional exposure. However, intentional GLP-1 RA use in planned pregnancy should remain avoided until larger agent-specific studies confirm safety.