Association Between GLP-1 Receptor Agonist Use and Postpartum Pelvic Complications: A Global Matched Cohort Study

Background Postpartum women experience high rates of urinary tract infections (UTIs), inflammatory genital conditions, and pelvic pain syndromes, which negatively affect quality of life and sexual health. Obesity and systemic inflammation may contribute to these complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), increasingly prescribed for weight management in non-diabetic individuals, have anti-inflammatory and immunomodulatory effects that may influence pelvic health; however, their role in postpartum pelvic morbidity has not been studied. The objective of this study was to evaluate the association between GLP-1RA use and postpartum pelvic complications including UTIs, inflammatory genital infections, and pelvic pain syndromes, in a large, global cohort of non-diabetic women. Methods We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Postpartum women prescribed GLP-1RAs were identified and matched 1:1 by propensity scores to non-users based on age, body mass index (BMI), hypertension, and race/ethnicity. Primary outcomes included incident UTIs, inflammatory genital conditions (e.g., vaginitis, vulvitis), and pelvic pain syndromes (including dyspareunia and vulvodynia). Outcomes were assessed using cumulative incidence following propensity score matching. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to compare risk between cohorts. Results After matching, 5,387 women remained in each cohort. GLP-1RA use was associated with significantly lower odds of UTIs (4.09% vs 6.94%; OR 0.571, 95% CI 0.461–0.707, p < 0.0001), inflammatory genital infections (12.19% vs 18.65%; OR 0.605, 95% CI 0.504–0.727, p < 0.0001), and pelvic pain syndromes (7.03% vs 11.98%; OR 0.555, 95% CI 0.465–0.663, p < 0.0001). Conclusions In this large, propensity-matched cohort of non-diabetic postpartum women, GLP-1RA use was associated with significantly reduced risks of infectious and pain-related pelvic complications after adjustment for baseline BMI. These findings suggest a potential protective association between GLP-1RA therapy and postpartum pelvic health and warrant prospective validation.