Outcomes of Maternal Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Scoping Review of Evidence and Reporting Trends.

OBJECTIVES

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have recently gained dramatic popularity and use in treating type 2 diabetes mellitus and obesity. Although reports of accidental periconceptional exposure to these drugs have emerged and are expected to increase, the limited evidence of their impact during pregnancy makes informed decision-making difficult. This scoping review aims to identify and comprehensively report available evidence regarding the periconceptional use of GLP-1 RAs and their effects on pregnancy outcomes.

METHODS

The review was conducted following the Joanna Briggs Institute methodology. All levels of evidence and types of reports regarding pregnancy outcomes after periconceptional exposure to GLP-1 RAs of individuals with type 2 diabetes mellitus or obesity were included. Databases including MEDLINE, Embase, Scopus, and open-access clinical trial registries were searched from January 1, 2005, to March 12, 2025. ProQuest Dissertations & Theses Global and medRxiv were also screened during the same period to include the most current reports. Studies were screened in duplicate at the abstract level, then at the full-text level by 2 independent reviewers, with disagreements resolved through consensus. The included articles were charted, and the data were summarized narratively and presented in the Table.

RESULTS

After eliminating duplicates, 881 articles were screened, and 13 articles, 10 case reports and 3 cohort studies, met eligibility criteria for inclusion. Minor pregnancy complications reported in the case reports included emergency cesarean delivery, preeclampsia, macrosomia, shoulder dystocia, and transient neonatal hypoglycemia. However, all studies did not find an increased risk of major congenital malformations. Pregnancy losses and elective termination of pregnancy were not reported in any study.

CONCLUSIONS

Accidental periconceptional exposure to GLP-1 RAs may not be associated with an increased risk of adverse pregnancy outcomes, particularly major congenital malformations and pregnancy loss. More high-level evidence will be warranted to confirm these findings and guide clinical decision-making.