An international panel of experts has published a systematic review and consensus guidelines on the use of incretin-based medications in women’s reproductive health, offering hospitals and clinicians recommendations for counseling patients before, during and after pregnancy, according to research published in Obesity Reviews.
The panel reviewed 34 studies examining GLP-1s including semaglutide, liraglutide, dulaglutide, exenatide, lixisenatide and tirzepatide in relation to preconception, pregnancy and postpartum care.
Here are five things to know:
- No studies included in the review reported an increased risk of congenital anomalies among an estimated 1,538 pregnancies exposed to incretin-based medications, most of which were inadvertent and limited to the first trimester.
- Some studies found a reduced risk of gestational diabetes, preterm birth and hypertensive disorders of pregnancy among women who used the drugs before conception, though researchers said the underlying condition prompting the prescription, rather than the medication itself, may be driving those outcomes.
- Human data on the drugs’ safety during breastfeeding remain limited. The only study identified found semaglutide was not detected in milk samples from eight participants who breastfed.
- Direct evidence was available for just 18 of 32 clinical research questions the panel examined, leaving gaps on nutrition, long-term outcomes for mothers and offspring, and optimal timing to start or stop treatment.
- The panel recommends against deliberately continuing incretin-based therapy throughout pregnancy and advises patients to discontinue the medication as soon as pregnancy is confirmed, noting there is no clear evidence to support specific washout periods beforehand. Women taking tirzepatide should use reliable non-oral contraception because the drug can reduce the effectiveness of oral hormonal birth control.
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