Dr Stacey Ehrenberg: More Research Needed on Use of GLP-1s During Pregnancy

Stacey Ehrenberg, MD, a maternal fetal medicine specialist at Cleveland Clinic, presented at a recent Institute for Value-Based Medicine^® event on the optimal approach to diabetes and obesity for patients who are pregnant. In a virtual interview, Ehrenberg discussed in greater detail the special considerations both patients and clinicians should be aware of in the use of glucagon-like peptide-1 (GLP-1) receptor agonists during pregnancy.

Transcript

This transcript has been lightly edited for clarity and length.

Are there any particular factors clinicians or patients should be aware of when considering GLP-1 receptor agonist therapy during pregnancy?

So using the GLP-1 agonists has been a huge topic of conversation, both in the medical field and in the general population. And so, we're getting a lot of questions about, “Can we use this in pregnancy?” We're hearing a lot about, you know, Ozempic babies or Mounjaro babies and people are like, “What does that mean?” And you know, “Is that safe? Can we do that?” And these medications are fantastic in trying to optimize a patient's hemoglobin A_1c, or their average blood sugars and their weight prior to pregnancy, or just in the general population.

In pregnancy, we really don't have a lot of data on the long-term effects. We certainly don't have data on the long-term effects of these medications. But we really don't even have a lot of short-term data, either. We've got some case reports, and there was one recent study that was published in JAMA, I believe, in January of 2024 of this year, looking at these medications in early pregnancy. And so far, we're a little bit hopeful that we may be able to not so much use these medications in the first trimester of pregnancy, but in patients who happened to be on them and didn't realize they were pregnant until 6, 8, 10, 12 weeks—which is common. We're hopeful that the data shows that we don't see any increased risk of birth defects and women who have been on these medications before pregnancy, and maybe even a little bit during the first trimester of pregnancy. It doesn't seem to be a concern for the babies.

What we do know is that later in pregnancy, in the second and third trimester, we have seen some increased risks with the baby's kidneys, with the baby's growth velocity. So I'm not sure that these are going to be medications that we can keep patients on throughout the entire pregnancy. Although, I think we need more data before I would feel very confident in saying that with certainty. But right now, I think it's best not to use them because we just don't have the information. And the information we do have is somewhat concerning. And whether it's the medication itself causing these complications in the babies or whether it's the weight loss and the inability to eat enough calories to support a pregnancy while on these medications is questionable. I can't really say what the mechanism of action is but the end result right now is that we're concerned about patients continuing on these medications into the second and third trimester, because we're worried that it can affect the health and wellbeing of the baby.