Semaglutide exposure during preconception and pregnancy surged in 2023, now leading anti-obesity medications in US claims data.
Background
The rising global prevalence of obesity among women of reproductive age has led to increased use of anti-obesity medications (AOMs). However, there are significant concerns regarding inadvertent fetal exposure to these drugs, as safety data during preconception and pregnancy are often limited or unknown. Current guidelines typically advise discontinuing AOMs prior to conception due to potential risks. This study addresses the critical gap in understanding the real-world prevalence and trends of AOM exposure in this vulnerable population, especially with newer, highly effective agents like semaglutide.
Study Design
Researchers conducted a retrospective cohort study using approximately 2 million pregnancies identified in commercial claims data from the MarketScan database. The study period spanned from 2018 to 2023. The primary objective was to investigate the prevalence and temporal trends of perinatal exposure to Food and Drug Administration (FDA)-approved AOMs. Exposure was defined as receiving an AOM prescription during the preconception or pregnancy period. The study identified specific AOMs, including phentermine and semaglutide, to analyze their individual contributions to overall exposure trends.
Results
Overall, 0.32% (n=6179) of the approximately 2 million pregnancies analyzed showed exposure to anti-obesity medications (AOMs). The prevalence of AOM exposure was notably higher among specific demographic groups: 1.1% in women aged over 40 years, 1.4% in those with pre-pregnancy obesity, and 1.2% in women with type 2 diabetes. Overall AOM exposure increased modestly from 2018 to 2022, but then experienced a marked rise between 2022 (0.31%) and 2023 (0.58%).
Prior to 2023, most AOM exposures involved phentermine; however, in 2023, semaglutide accounted for the highest prevalence of exposure during preconception and pregnancy.
Key Findings
- Overall, 0.32% (n=6179) of approximately 2 million pregnancies were exposed to anti-obesity medications (AOMs).
- AOM exposure was highest in women >40 years (1.1%), with pre-pregnancy obesity (1.4%), or type 2 diabetes (1.2%).
- Overall AOM exposure rose significantly from 0.31% in 2022 to 0.58% in 2023.
- Prior to 2023, phentermine was the most common AOM, but semaglutide became the highest in 2023.
Why It Matters
The rapid increase in semaglutide exposure during preconception and pregnancy necessitates urgent research into maternal and fetal outcomes. This finding highlights a critical public health concern for clinicians, pharmacists, and women of reproductive age. Current protocols often recommend discontinuing AOMs before conception, yet real-world data show increasing exposure. This trend underscores the need for enhanced patient counseling, clearer prescribing guidelines, and robust post-market surveillance to assess the safety profile of newer AOMs like semaglutide in pregnancy. Without this data, healthcare providers lack the evidence to properly advise patients, potentially leading to unintended fetal exposure and unknown long-term consequences.
TitrateLab articles covering Semaglutide
Written by TitrateLab, separately from the study summarized above.
semaglutide
anti-obesity-medications
pregnancy
preconception
obesity
public-health
