GLP-1 Receptor Agonists: Essential Considerations for OB/GYN Practice

GLP-1 receptor agonists (GLP-1 RAs), such as semaglutide and liraglutide, are increasingly prescribed for the management of type 2 diabetes and obesity, conditions that disproportionately affect women of reproductive age. As their use becomes more widespread, obstetricians and gynecologists (OB/GYNs) are encountering more patients on these medications or considering them. There is a pressing need for comprehensive guidance on the implications of GLP-1 RA use in this specific patient population. This review synthesizes the current scientific understanding and clinical recommendations regarding GLP-1 RAs, focusing on their impact on women's reproductive health, fertility, pregnancy, and lactation.

The review highlights that GLP-1 RAs are highly effective for weight management and glycemic control, offering significant benefits for women with conditions like polycystic ovary syndrome (PCOS) or those at elevated risk for gestational diabetes. It underscores the critical importance of discontinuing these medications prior to conception due to a notable lack of robust human pregnancy safety data, while acknowledging that some animal studies have indicated potential adverse effects at higher doses. The authors noted that while GLP-1 RAs can indirectly improve fertility outcomes by facilitating weight reduction in obese individuals, their direct impact on reproductive hormones and ovulation requires more dedicated investigation. > The review strongly recommends that GLP-1 receptor agonists should be discontinued at least 2 months before planned conception, a crucial guideline given the insufficient human pregnancy safety data currently available. Furthermore, the review discussed the potential for GLP-1 RAs to influence the absorption of oral contraceptives, though the evidence for clinically significant drug-drug interactions remains limited and requires further study. The authors ultimately emphasized the paramount need for individualized patient counseling regarding the known risks and potential benefits, particularly for women of reproductive potential who are considering or currently using these medications.