Prepregnancy <scp>GLP</scp> ‐ <scp>1RA</scp> Exposure and Risk of Hypertensive Disorders of Pregnancy Among Women With Obesity and Diabetes

OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed to women of reproductive age for obesity, type 2 diabetes, obstructive sleep apnea, and more. Data on pregnancy outcomes following prepregnancy exposure remain limited. We evaluated associations between prepregnancy GLP-1RA exposure and maternal and neonatal outcomes among women with preexisting obesity and diabetes. METHODS: We conducted a retrospective cohort study using electronic health records data. Prepregnancy GLP-1RA exposure was defined by prescription orders within 12 and 24 months prior to delivery. Propensity score matching was performed using maternal age, race and ethnicity, prepregnancy obesity status, diabetes type, chronic hypertension, insurance type, and rurality. Primary outcomes included preeclampsia (PE). Secondary outcomes included cesarean delivery, infant growth, gestational age at delivery, and neonatal intensive care unit length of stay. RESULTS: Among 31 exposed pregnancies, 29 were matched to unexposed controls. GLP-1RA exposure was associated with higher prevalence of PE (12 months: p = 0.023; 24 months: p = 0.018). Cesarean delivery occurred more frequently among exposed pregnancies (p < 0.05). No differences were observed in neonatal outcomes after matching. CONCLUSIONS: Prepregnancy GLP-1RA exposure was associated with higher prevalence of PE and cesarean delivery in this cohort. Larger studies are needed to confirm these findings and clarify underlying mechanisms.