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Hypertensive disorders of pregnancy and GLP-1 receptor agonist timing: a systematic review and meta-analysis

Endocrine·July 31Open Access
Endocrinology & MetabolismLimited evidenceHypertensive Disorders Of PregnancyObesityPreeclampsiaType 2 Diabetes MellitusSystematic Review And Meta-AnalysisGLP-1 Receptor AgonistAdultAlbiglutideDulaglutideExenatideLiraglutideLixisenatideSemaglutideTirzepatide

Summary

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What was studied

This systematic review and meta-analysis examined whether periconceptional or first-trimester exposure to GLP-1 receptor agonists (semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, albiglutide) was associated with hypertensive disorders of pregnancy (HDP), pooling data from 3 retrospective US cohort studies (2014–2025) covering 10,880 pregnancies (4,942 exposed, 5,938 unexposed).

Key findings

Pooled analysis showed no statistically significant association between GLP-1 RA exposure and HDP risk (OR 0.91, 95% CI 0.57–1.47); 2 of 3 studies found lower HDP risk in exposed women (ORs 0.56 and 0.84), while 1 found higher risk, with high heterogeneity across studies.

Study limitations

- Only 3 retrospective cohort studies were available, all from the US, limiting generalizability. - Two studies relied on ICD-10 codes for HDP diagnosis, which may underreport or misclassify cases. - Abrupt GLP-1 RA discontinuation before conception may cause gestational weight rebound, confounding the HDP risk estimate.

Clinical implications

Current evidence does not support a significant protective or harmful effect of periconceptional or first-trimester GLP-1 RA use on HDP risk; clinicians should counsel patients that data are insufficient to guide decisions, and large prospective studies are needed before changing practice.

Related Questions

Explore related topics

What are the risks of continuing GLP-1 receptor agonists during early pregnancy?Does stopping semaglutide before conception increase gestational weight gain and pregnancy complications?How do GLP-1 receptor agonists affect preeclampsia risk in women with obesity or type 2 diabetes?

Publication Details

Year
2026
Journal
Endocrine
Sample Size
n=10,880
Source
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