September 29, 2026

Scientist comments on a systematic review and meta-analysis, published in Med, investigating GLP-1 RA exposure in the periconceptional period and adverse obstetric outcomes. 

Dr Adam Watkins, Senior Lecturer in Reproductive Medicine at the University of Sheffield’s School of Medicine and Population Health, said:

“Currently, GLP-1 receptor agonists (such as Ozempic, Wegovy, or Mounjaro) are not approved for use during pregnancy. However, with the rising number of people taking GLP-1 receptor agonists, women may still be exposed to them during the initial stages of pregnancy. This study analysed data collected from 10 existing studies (in a process called a meta-analysis) to establish associations between GLP-1 receptor agonist use in pregnancy and the potential for adverse complications. After analysing data from over 2.1 million pregnancies, the authors found no increase in the rates of miscarriage, congenital abnormalities, preterm birth, altered fetal growth or poor maternal cardio-metabolic health.

“While the study included data from over 2.1 million pregnancies, this was only taken from 10 separate studies. Using just 10 studies in total could expose the data, and the conclusions drawn from it, to potential bias from individual studies. Indeed, the authors reported that for some of the factors studied, such as preterm birth, maternal weight gain and gestational conditions like preeclampsia and gestational diabetes, there was a high degree of variability between the studies. Therefore, caution is still required before advising women to take GLP-1 receptor agonists during pregnancy.  

“Despite the variability in the data analysed, the conclusions from this study are in line with other similar studies which also indicate GLP-1 receptor agonist use in pregnancy is not associated with increased maternal, fetal or neonatal risk. However, more clinical and fundamental studies are required to explore the safety of GLP-1 receptor agonists both before and during pregnancy.”

Dr Marie Spreckley, Weight Management Researcher, University of Cambridge, said:

“This review analysed ten observational studies, nine of which were included in the meta-analysis. Using adjusted results and looking at several pregnancy outcomes are strengths. However, the headline figure of 2.1 million women needs context: 8,325 had reported exposure, and smaller groups informed each individual outcome. The miscarriage or intrauterine death analysis drew on just two datasets with 1,138 participants in total, and its estimate remains compatible with both lower and higher odds among exposed women compared with unexposed women.

“The studies also differed in when they counted someone as exposed and why women were taking these medicines. Although the researchers accounted for other factors, differences in health and care between the exposed and comparison groups could still have affected the results.

“These findings may offer some reassurance to women who took one of these medicines before realising they were pregnant. But finding no clear increase in risk does not establish that the medicines are safe during pregnancy or change the advice to stop treatment before a planned pregnancy.”

Prof Tricia Tan, Professor of Metabolic Medicine and Endocrinology, Imperial College London, said:

“We welcome this new publication, which updates the known information with regards to GLP-1RA and their use in women prior to conception. This paper includes the latest data and has a larger number of participants than before. The message is broadly reassuring in that there was no detectable serious problem for pregnancy outcomes.

“However, such studies are always limited by the fact that they are looking at past practice, which may not reflect current practice in which women are using these medications in higher doses to achieve better weight loss and improvements in metabolism than might have occurred in the studies making up this analysis.

“We call for a concerted effort by the research community and the pharmaceutical industry to set up prospective studies which properly collect data on modern GLP-1RA agents and their use to provide women who are thinking of using these medications to manage their obesity with the reassurance they deserve.”

‘GLP-1 receptor agonist exposure in the periconceptional period and adverse obstetric outcomes: A systematic review and meta-analysis’ by Francesco D’Antonio et al. was published in Med at 16:00 UK time on Tuesday 29 September 2026.

DOI: 10.1016/j.medj.2026.101267

Declared interests

Dr Adam Watkins: “Dr Watkins has no interests to declare regarding this research however he currently has funding from the British Heart Foundation to support a non-clinical PhD studentship in my lab (award BHF FS/PhD/24/29259).“

Dr Marie Spreckley: “Dr Marie Spreckley is a postdoctoral researcher at IMS Epidemiology, University of Cambridge, where her research focuses on nutrition and weight management. She has no financial relationships with food or beverage companies, pharmaceutical companies, or other commercial organisations, and has received no industry funding for her research.”

Prof Tricia Tan: “Prof Tan declares that she is a former shareholder in and consultant for Zihipp Ltd. (now part of Pfizer). Serves on advisory boards for Nxera, Amylyx. Previous consultancy for Roche and Astra-Zeneca. Principal investigator for trial for Recordati Rare Diseases.”