Preconception Use of GLP-1RA and SGLT2i in Pregnant Women with Diabetes in a Large Integrated Health Care System: Impact on Pregnancy Outcomes

Introduction and Objective: Rising use of GLP-1 receptor agonists (including GIP/GLP-1 RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) has increased preconception and early-pregnancy exposure. This study assessed their use and impact on maternal-neonatal outcomes. Methods: Using ICD-10 codes, maternal-neonatal outcomes were compared in women with and without diabetes delivering between 5/1/2022 and 6/30/2024 within Sutter Health. Outcomes were assessed by medication exposure within 12 months preconception and during the first trimester. Results: Among 9,800 individuals with diabetes and 40,178 without, 166 and 89 respectively were exposed to medications. Exposed women with diabetes had higher rates of hypertension, pre-pregnancy BMI, and HbA1c in each trimester. Medication exposure in women with diabetes was associated with significantly higher adverse outcomes; preterm birth, pre-eclampsia, C-section, NICU admission, neonatal respiratory distress, macrosomia, and neonatal hypoglycemia (Table, all p < 0.001). Similar outcome trends were observed among exposed women without diabetes. Conclusion: Preconception and early-pregnancy use of GLP-1 RA or SGLT2i was associated with higher adverse pregnancy outcomes, likely reflecting higher baseline risk rather than medication exposure alone. Disclosure: F. Farrokhi: None. Y. Guo: None. R. Lane: None. K. Hays: None. M. Antuna: None. N. Dillard: None. H. Husby: None. D. Kerr: Stock/Shareholder; Current; Glooko, Inc. Research Support; Current; Abbott Diabetes. Funding: Eli Lilly and Company (A-37724)