Are Glp-1 Drugs Safe For Women Planning Pregnancy?

New nationalist information uncover a crisp emergence successful GLP-1 prescriptions for young women, but debased contraception usage leaves galore astatine consequence of unintended gestation and uncertain outcomes for their babies.

Study: Incidence of GLP-1 receptor agonist usage by women of reproductive property attending wide practices successful Australia, 2011–2022: a retrospective unfastened cohort study. Image credit: Tetiana_Kryvous/Shutterstock.com

A caller study successful nan Medical Journal of Australia examines nan usage of glucagon-like peptide 1 (GLP-1) receptor agonists (RAs) successful reproductive-age women successful Australia to efficaciously negociate type 2 glucosuria mellitus, on pinch contraception overlap and gestation incidence successful this population.

Introduction

GLP-1 RAs enactment for illustration nan earthy hormone GLP-1, stimulating insulin secretion successful nan beingness of precocious humor sweetener levels. Initially investigated for nan guidance of diabetes, their marked weight-loss induction effects led to their expanding usage off-label for weight loss.

About 1% of Australian women of reproductive property person type 2 diabetes, and much than 40% of women pinch type 2 glucosuria are besides overweight aliases obese. Consequently, 1% of pregnancies are analyzable by type 2 diabetes, vs 50% of pregnancies pinch overweight aliases obesity. Preconception attraction is basal for women pinch glucosuria aliases excess assemblage weight to amended gestation outcomes, peculiarly since 40% of pregnancies successful Australia are unplanned.

The usage of GLP-1 RAs for weight guidance is apt to amended fertility because of moreover humble weight loss. Yet, their information during gestation remains unclear. Animal studies bespeak fetal maturation restriction, ossification delay, skeletal variants, and reduced maternal weight gain, though much caller quality evidence, including a 2024 cohort of 938 pregnancies, suggests nary accrued consequence of awesome congenital malformations compared pinch insulin. However, information concerns widen beyond malformations, and different imaginable adverse gestation outcomes were not examined.

Current UK guidelines counsel against their usage successful gestation and urge concurrent effective contraception for women utilizing them during their reproductive years. Yet fewer women who commencement GLP-1 RAs are connected contraception. A important proportionality of these women go pregnant soon aft opening curen pinch these agents.

The existent study sought to understand GLP-1 RA usage among Australian women successful their reproductive years, on pinch compliance pinch contraception recommendations, and nan incidence of pregnancy, successful this subgroup.

About nan study

The study included 1,635,684 women aged 18 to 49, of whom 18,010 were first prescribed GLP-1 Ras betwixt January 1, 2011, and July 31, 2022. Of these, 3,739 women, making up 21% of nan total, were reported to person type 2 diabetes.

Study findings

The incidence of GLP-1 RA medicine successful nan subgroup of reproductive-age women pinch type 2 glucosuria stood astatine 13 per 1,000 women successful 2011, expanding to 88.5 per 1,000 women successful 2022. Women successful nan aforesaid property group who did not person type 2 glucosuria had an incidence of 15 per 1,000 women successful 2022, compared to zero astatine baseline.

Of nan 6,954 women who received GLP-1 RA prescriptions successful 2022, 91% of them did not person type 2 diabetes, indicating that off-label usage made up astir prescriptions.

About 21% of nan cohort had capable physics wellness grounds information to find contraception overlap pinch nan play of GLP-1 RA initiation. In this subgroup, astir 17% of treated women pinch type 2 glucosuria were connected contraception astatine this clip vs 23% of those without diabetes. About 6% and 9% of women connected GLP-1 RAs pinch and without type 2 glucosuria utilized long-acting reversible contraception methods, compared to 11% wide for Australian women.

There were 232 pregnancies among 10,781 women wrong six months of being prescribed these agents, considering only women who could beryllium followed up for astatine slightest this period. Women connected contraception erstwhile they started GLP-1 RAs were 40% little apt to conceive complete nan adjacent six months.

About 4% of women aged 18-29 who had type 2 glucosuria and were connected GLP-1 RAs became pregnant, nan highest complaint among each property groups. Conversely, among non-diabetic women, nan highest complaint was 6% among those aged 30-34 years. Women who conceived wrong six months of starting GLP-1 RAs were doubly arsenic apt to person polycystic ovary syndrome compared to those who did not.

Conclusions

GLP-1 RAs are being progressively prescribed among women wrong nan reproductive play successful Australia, irrespective of nan beingness of type 2 diabetes. Most women prescribed these medications did not person type 2 diabetes. This suggests that these are being progressively utilized off-label for weight nonaccomplishment and different non-diabetes indications.

More than 75% of these women do not usage contraceptives erstwhile initiating nan usage of these agents. This indicates nan request for much investigation to find guidelines that tin guarantee GLP-1 RAs are utilized safely and efficaciously successful this group of women, including those pinch type 2 diabetes, obesity aliases overweight, and polycystic ovary syndrome.

The study besides noted that nan accelerated emergence successful prescribing since 2020 coincided pinch nan support and PBS listing of semaglutide successful Australia, which apt drove overmuch of nan caller increase. There is an urgent request to place nan imaginable effects of these narcotics connected nan fetus.

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