December 03, 2025
3 min read
Key takeaways:
- Women who used a GLP-1 before pregnancy were more likely to develop preeclampsia than nonusers.
- A smaller percentage of prepregnancy GLP-1 users developed gestational diabetes vs. controls.
ATLANTA — Women who used a GLP-1 prior to pregnancy and stopped therapy 1 to 2 years before delivery had increased risk for preeclampsia, but reduced risk for developing gestational diabetes, according to study findings.
Dominick J. Lemas, PhD, assistant professor in the department of health outcomes and biomedical informatics, and faculty member at the Institute for Child Health Policy at University of Florida College of Medicine, said the FDA currently recommends that women stop using GLP-1s at least 2 months before conception due to fetal toxicity that was observed in some animal studies. However, with GLP-1 use growing in the U.S., Lemas said it is crucial to examine how GLP-1 exposure before pregnancy affects health outcomes for mothers and their offspring, especially as nearly half of pregnancies in the U.S. are unplanned.
Data were derived from Lemas DJ, et al. Oral-076. Presented at: ObesityWeek; Nov. 4-7, 2025; Atlanta.
“There’s limited real-world data that exists on the timing of [GLP-1] discontinuation relative to conception and delivery, with little evidence to balance metabolic benefits of maternal weight loss against the potential maternal fetal risk,” Lemas said during a presentation at ObesityWeek.
Researchers conducted an exploratory analysis of women who delivered a baby in the University of Florida Health perinatal catchment area and used a GLP-1 2 years or less before delivery. Mothers who used a GLP-1 were matched by maternal age, race and ethnicity and comorbidities with mothers without GLP-1 use who delivered a baby. All data were collected through electronic health records.
Study outcomes
There were 29 mothers who used a GLP-1 prior to delivery (mean age, 31 years; mean BMI, 43 kg/m2) matched with 29 mothers who never used a GLP-1. Liraglutide (Saxenda, Novo Nordisk) was the most common GLP-1 in the study and was used by 50% of participants who received a GLP-1 1 year before delivery and 48.3% of those receiving a GLP-1 2 years before delivery.
A higher proportion of women who used a GLP-1 1 year before delivery (P = .023) and 2 years before delivery (P = .018) developed preeclampsia vs. women who did not use a GLP-1.
Among women who used a GLP-1 1 year before delivery, 11% developed gestational diabetes vs. 53% of women who did not use a GLP-1 (P = .005). Women who used a GLP-1 2 years before delivery were also less likely to develop gestational diabetes than matched controls who did not use a medication (21% vs. 48%; P = .027).
Cesarean delivery rates were higher among women using a GLP-1 1 year prior to delivery (P = .007) and 2 years before delivery (P = .033) vs. non-GLP-1 users.
Neonatal outcomes, including birth weight, gestational age, fetal growth and stay in the neonatal ICU, did not differ between GLP-1 users and controls.
More research needed
Lemas said there are several potential mechanisms that may explain the associations observed in the study.
“For patients who are discontinuing GLP-1s before pregnancy, there will be some who have improved insulin sensitivity that extends beyond when you are actively on the drug,” Lemas said. “This may lower your risk of gestational diabetes. In contrast, there’s also the possibility some patients will experience a significant cardiometabolic rebound characterized by rising blood pressure, inflammation and gestational weight gain. This may explain why some patients would have higher risk of preeclampsia or hypertensive disorders in pregnancy, and may also explain why these patients were delivered by cesarean section.”
Lemas said the sample size for the study was small, and larger real-world studies involving multiple sites are needed. Lemas said his institution is one of many that are part of the OneFlorida Clinical Research Consortium, which included EHR data from more than 400,000 mothers and infants.
“We’d like to distinguish between short-acting and long-acting GLP formulations and their differential effects on maternal-infant outcomes that includes longitudinal follow-up and mechanistic clinical studies to clarify the vascular and metabolic pathways impacted by GLP-1 discontinuation,” Lemas said of future research.
Sources/Disclosures
Source:
Lemas DJ, et al. Oral-076. Presented at: ObesityWeek; Nov. 4-7, 2025; Atlanta.
Disclosures:
Lemas reports no relevant financial disclosures.
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