2150-P: Association between GLP-1 Receptor Agonist Use during Pregnancy and Adverse Birth Outcomes

Introduction and Objective: Safety of GLP-1 Receptor Agonists (GLP-1RA) during pregnancy remains understudied. We investigated whether GLP-1RA use during pregnancy is associated with adverse birth outcomes compared with other diabetes medications. Methods: Utilizing population-level data from Epic Cosmos (N>300million), we examined use of GLP-1RAs including semaglutide, liraglutide, dulaglutide, exenatide, or tirzepatide (N=46,174), insulin (N=168,439), metformin (N=212,779), and no diabetes medications (N=7,165,344) overlapping with pregnancy. We included diabetes, obesity, and gestational diabetes diagnoses and excluded those on multiple medications. We compared outcomes including prematurity, birth size, and common congenital anomalies. Analysis was performed with odds ratios (95% CI) for adverse birth outcomes across treatment groups. Results: Compared to no diabetes medication use during pregnancy, use of insulin, metformin, and GLP-1RAs was associated with greater odds of adverse birth outcomes in the majority of the outcomes. GLP-1RA had lower risk of adverse birth outcomes compared to insulin and similar risk compared to metformin. Conclusion: In a population-based, real-world study, prenatal exposure to insulin, metformin, and GLP-1 RA was associated with increased adverse birth outcomes compared to no diabetes medication use. Compared to GLP-1RA, risk of adverse birth outcomes was similar for metformin and increased for insulin. Disclosure A. Finkle: None. S. Paek: None. S. Baptiste: None. J. Ryder: Stock/Shareholder; Current; Calorify. Research Support; Current; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Recordati S.p.A. J. Josefson: None.