GLP-1 exposure around conception: no clear signal, but not proof of safety

The edition in brief

A BJOG narrative review of observational data found no clear safety signal after inadvertent periconception exposure to GLP-1 receptor agonists, but the data are small, confounded and cannot exclude important risks; it favours individualised counselling. A secondary analysis of two randomised trials in 291 women with preterm pre-eclampsia under expectant management found that higher 24-hour proteinuria went with shorter latency (median 15.3, 10.0 and 4.9 days across below 3, 3 to 5 and 5 g or more) and more maternal complications (8.8%, 16.1%, 27.9%), but not perinatal ones. A Swedish register study built and temporally validated a prediction model for anal incontinence at one year after second- to fourth-degree tears (AUC 0.78). A meta-analysis of six cohorts (2,166 women) found late gestational diabetes in 15.0% of women with normal mid-pregnancy screening who were retested for suspected large-for-gestational-age fetuses or polyhydramnios; the rate was 20.8% for suspected large-for-gestational-age fetuses and 4.8% for isolated polyhydramnios, with higher odds of neonatal hypoglycaemia and caesarean delivery.