Preconception GLP RA-1 | Recording-Preconception GLP RA-1

Video Transcription

Video Summary

The webinar, hosted by the ADA Pregnancy and Reproductive Health Interest Group, focused on the preconception use of GLP-1 receptor agonists, medications increasingly prescribed for type 2 diabetes, obesity, and related conditions. Dr. Jacqueline Maya and Dr. Christopher Now discussed the pharmacology, indications, and increasing usage of GLP-1 receptor agonists (e.g., liraglutide, semaglutide, dulaglutide, and the dual agonist tirzepatide) particularly among women of childbearing age amid rising diabetes and obesity rates.<br /><br />Animal studies have indicated potential risks of congenital malformations and fetal growth restriction with GLP-1 use during early pregnancy, leading current recommendations to stop these medications at least two months before conception. However, human data remain limited but somewhat reassuring; retrospective cohorts found no significant increase in major congenital malformations or cardiac defects with first-trimester exposure compared to insulin. Placental transfer studies suggest minimal fetal exposure due to the large molecular size of these drugs.<br /><br />The speakers emphasized balancing risks of medication exposure against the risks of untreated diabetes/obesity during pregnancy, highlighting the importance of preconception counseling and individualized care coordination across specialties. Emerging data suggest that preconception GLP-1 agonist use may lower gestational diabetes and hypertensive disorders rates but could increase preterm delivery risk and gestational weight gain.<br /><br />Limited evidence on breastfeeding indicates minimal drug transfer into breast milk, supporting breastfeeding continuation. Both speakers agreed the evidence is still evolving, especially regarding second/third trimester exposure, and called for more research to optimize medication management before conception, during pregnancy, and postpartum to improve outcomes for both parent and child.

Keywords

GLP-1 receptor agonists

preconception use

type 2 diabetes

obesity

pregnancy risks

congenital malformations

fetal growth restriction

gestational diabetes

breastfeeding safety

medication management