Glucagon-Like Peptide 1 Receptor Agonist Prescription prior to Pregnancy According to Health Insurance Type and Race/Ethnicity

Introduction and Objective: Prior studies have found disparities in prescription of glucagon-like peptide-1 receptor agonists (GLP1 RAs) in the general population. We investigated GLP1 RA prescription patterns in the preconception period. Methods: In a retrospective electronic health record-based cohort, we studied GLP1 RA prescription in the 3 years before conception (outcome), among those with pre-pregnancy BMI ≥ 25 kg/m2. In separate models, we examined associations between the following binary predictor variables and GLP1 RA prescription: health insurance (public or private), minoritized race/ethnicity (not self-identified as non-Hispanic White), Asian race, Black race and Hispanic ethnicity. We fit generalized estimating equation models to examine the odds of receiving a GLP1 RA prescription; covariates included age, BMI, diabetes, hypertension, obesity class, insurance (in race/ethnicity models), and race/ethnicity (in insurance models). Results: Among a cohort of 53,404 pregnancies in 41,932 individuals, 21.7% had public insurance, 41.4% had a minoritized race/ethnicity and 0.4% were exposed to GLP1 RA prior to pregnancy. In adjusted models, pregnancies with public insurance had lower odds of preconception GLP1 RA prescription (OR 0.30, 95% CI 0.19-0.46) compared to those with private insurance. The odds of a GLP1 RA prescription were higher among pregnancies with a minoritized race/ethnicity (OR 2.39, 95%CI 1.76-3.25) compared to those with a non-minoritized race/ethnicity. In comparison to pregnancies of non-Hispanic individuals, those of Hispanic individuals had higher odds of GLP1 RA prescription (OR 2.56, 95% CI 1.86-3.54). Asian or Black race was not associated with GLP1 RA prescription. Conclusion: Private insurance and Hispanic ethnicity are associated with preconception GLP1 RA prescription. These findings may inform understanding of disparities in pregnancy outcomes associated with preconception GLP1 RA use. Disclosure: C.I. Batlle: None. S. Hsu: None. K. James: None. D. Pant: None. T. Thaweethai: None. C.E. Powe: Research Support; Dexcom, Inc. Other Relationship; Mediflix, Wolters Kluwer Health. J. Maya: None. Funding: American Diabetes Association (9-24-JDFWH-010); NIDDK (K26DK138346, T32DK007028MGH ); Physician/Scientist Development Award