Imbroane Marisa R, LeMoine Felicia, Nau Christopher T
School of Medicine, Case Western Reserve University, Cleveland, OH.
Department of Reproductive Biology, The MetroHealth System/Case Western Reserve University, Cleveland, OH.
Am J Obstet Gynecol. 2025 Jan 21. doi: 10.1016/j.ajog.2025.01.019.
The use of glucagon-like peptide-1 receptor agonists has greatly increased in patients of reproductive age within the past 4 years. However, there is limited research on the long-term effects of these medications on future pregnancies.
This study aimed to evaluate the association between adverse obstetrical outcomes and antecedent glucagon-like peptide-1 receptor agonist use using a nationally representative database.
This was a retrospective cohort study of female patients aged ≥18 years using the US Collaborative Network in TriNetX. The exposure cohort was composed of individuals who received a glucagon-like peptide-1 receptor agonist prescription within the 2 years preceding pregnancy. The unexposed cohort was composed of individuals with a history of pregnancy but no previous history of glucagon-like peptide-1 receptor agonist use. The cohorts were matched for age, race, ethnicity, and history of comorbid conditions. The International Classification of Diseases, Tenth Revision, codes for hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm delivery, and rates of cesarean delivery were the primary outcomes of interest compared between the cohorts. Logistic regression was performed using TriNetX to determine the odds ratios and 95% confidence intervals.
After matching, there were 4267 individuals in each cohort. Compared with individuals who had no prescription for glucagon-like peptide-1 receptor agonist, those who had a prescription for glucagon-like peptide-1 receptor agonist were less likely to develop gestational diabetes mellitus (18.2% vs 15.2%, respectively; odds ratio, 0.81; 95% confidence interval, 0.72-0.91) and hypertensive disorders of pregnancy (22.8% vs 19.9%, respectively; odds ratio, 0.84; 95% confidence interval, 0.76-0.94), experience preterm delivery (4.4% vs 3.0%, respectively; odds ratio, 0.68; 95% confidence interval, 0.54-0.85), and undergo cesarean delivery (19.7% vs 17.6%, respectively; odds ratio, 0.89; 95% confidence interval, 0.87-0.97).
The prescription of glucagon-like peptide-1 receptor agonist within 24 months preceding a pregnancy was associated with a reduced risk of several adverse obstetrical outcomes, including gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and cesarean delivery. This suggests that the use of glucagon-like peptide-1 receptor agonists may be a powerful tool to improve perinatal outcomes in high-risk populations. However, future research is needed to define how this class of medication is best incorporated clinically into preconception health optimization.
在过去4年中，育龄期患者使用胰高血糖素样肽-1受体激动剂的情况大幅增加。然而，关于这些药物对未来妊娠的长期影响的研究有限。
本研究旨在使用具有全国代表性的数据库评估不良产科结局与先前使用胰高血糖素样肽-1受体激动剂之间的关联。
这是一项对年龄≥18岁的女性患者进行的回顾性队列研究，使用美国TriNetX协作网络。暴露队列由在妊娠前2年内接受过胰高血糖素样肽-1受体激动剂处方的个体组成。未暴露队列由有妊娠史但无胰高血糖素样肽-1受体激动剂使用史的个体组成。对队列进行年龄、种族、民族和合并症病史匹配。妊娠高血压疾病、妊娠期糖尿病、早产和剖宫产率的国际疾病分类第十版编码是队列之间比较的主要关注结局。使用TriNetX进行逻辑回归以确定比值比和95%置信区间。
匹配后，每个队列中有4267人。与未接受胰高血糖素样肽-1受体激动剂处方的个体相比，接受过胰高血糖素样肽-1受体激动剂处方的个体患妊娠期糖尿病的可能性较小（分别为18.2%和15.2%；比值比为0.81；95%置信区间为0.72-0.91）、妊娠高血压疾病（分别为22.8%和19.9%；比值比为0.84；95%置信区间为0.76-0.94）、早产（分别为4.4%和3.0%；比值比为0.68；95%置信区间为0.54-0.85）和剖宫产（分别为19.7%和17.6%；比值比为0.89；95%置信区间为0.87-0.97）。
妊娠前24个月内使用胰高血糖素样肽-1受体激动剂与包括妊娠期糖尿病、妊娠高血压疾病、早产和剖宫产在内的几种不良产科结局风险降低相关。这表明使用胰高血糖素样肽-1受体激动剂可能是改善高危人群围产期结局的有力工具。然而，需要进一步研究来确定如何在临床上最好地将这类药物纳入孕前健康优化。
