September 29, 2026

expert reaction to a systematic review and meta-analysis looking at preconception, pregnancy, and postnatal use of GLP-1 RAs in women with diabetes

Scientist comment on a systemic review and meta-analysis, published in The Lancet Obstetrics, Gynaecology & Women’s Health, looking at preconception, pregnancy, and postnatal use of GLP-1 RAs in women with diabetes.

Dr Nerys Astbury, Associate Professor – Diet & Obesity, Nuffield Department of Primary Health Care Sciences, University of Oxford, said:

“This is an interesting and much-needed review, particularly given the rapidly increasing use of GLP-1 receptor agonists and growing interest in the potential effects of exposure around conception and during pregnancy.

“However, I think the conclusions go beyond what the available evidence can currently support and should be interpreted with considerable caution.

“The key message from these results is not that GLP-1 receptor agonists have been shown to be safe during pregnancy, but that there is currently insufficient evidence to determine whether first-trimester exposure increases or decreases the risk of the pregnancy outcomes examined.

“For congenital anomalies, preterm birth, hypertensive disorders of pregnancy, stillbirth, neonatal death, caesarean delivery and small-for-gestational-age birth, the 95% confidence intervals around the pooled estimates include the null effect. The findings are therefore compatible with no association, but also with differing degrees of benefit or harm depending on the precision of the individual estimates.

“Similarly, there is currently insufficient evidence of an association between first-trimester GLP-1 receptor agonist exposure and early pregnancy loss, including miscarriage or termination. Again, the confidence intervals include the null effect, meaning that these findings should not be interpreted as demonstrating either an increased or decreased risk.

“There are also important limitations to the evidence base. These analyses are based on a relatively small number of available studies, and substantial heterogeneity is present for some outcomes. This means that the studies are producing quite different effect estimates, potentially because of differences in the populations studied, exposure definitions, comparators, outcomes, study designs or methodological quality. Where heterogeneity is substantial, a single pooled estimate may not adequately represent the effects observed across different populations and settings.

“Overall, I would interpret this review more cautiously. It provides useful evidence that can help define what we currently know, but it does not resolve the question of safety. The most important conclusion is that considerable uncertainty remains, and larger, high-quality studies are needed to establish the effects of GLP-1 receptor agonist exposure around conception and during pregnancy.”

‘Preconception, pregnancy, and postnatal use of GLP-1 receptor agonist-based therapies in women with type 1, type 2, or gestational diabetes: a systematic review, meta-analysis, and international expert consensus statement’ by Sarah Dib et al. was published in The Lancet Obstetrics, Gynaecology & Women’s Health at 23:01 UK time on Tuesday 29 September 2026.

DOI: 10.1016/S3050-5038(26)00266-9

Declared interests

Dr Nerys Astbury: “I have no conflicts “