Study Reveals Risks of Discontinuing Diabetes Drugs Before Pregnancy

A recent study has raised concerns about the health risks associated with discontinuing certain diabetes and weight-loss medications before or during early pregnancy. The analysis, published in JAMA Network, examined the health records of women prescribed GLP-1 receptor agonists, including semaglutide, tirzepatide, and liraglutide, which are commonly used for managing type-2 diabetes and obesity.

The research focused on 1,792 matched pregnancies from the Mass General Brigham health system in the United States. Of these pregnancies, 448 involved women who had discontinued the use of GLP-1 medications, while 1,344 had no prior exposure to these drugs. The study’s findings indicate a notable difference in pregnancy-related outcomes between the two groups.

Women who stopped taking GLP-1 drugs gained an average of 30.2 pounds during pregnancy, compared to 23.1 pounds for those who had not used these medications. Additionally, 65 percent of the women who discontinued the drugs experienced excess gestational weight gain, compared to 49 percent in the unexposed group. The study also identified higher rates of several complications among those who had ceased medication use.

Pregnancy Complications Linked to Medication Discontinuation

The findings revealed that preterm delivery rates were 17 percent among the exposed pregnancies, versus 13 percent in those not exposed to the medications. Furthermore, 20 percent of the women who had stopped taking the drugs developed gestational diabetes, compared to 15 percent in the unexposed group. The occurrence of hypertensive disorders during pregnancy was also significantly higher, affecting 46 percent of the exposed group, compared to 36 percent in the unexposed group.

Dr. Jacqueline Maya, who led the study at Massachusetts General Hospital, emphasized that these findings suggest metabolic changes may occur when women stop using GLP-1 drugs prior to or during pregnancy. While many patients benefit from these medications before conception, they may face new health risks if they discontinue use as advised.

Despite the complications observed, birth outcomes showed few significant differences between the two groups. The average birth weight percentile was slightly higher among those exposed to GLP-1 drugs, but there were no notable differences in birth length, rates of large or small for gestational age babies, or cesarean delivery rates.

Need for Further Research

An accompanying editorial highlighted the existing connections between obesity and related health conditions, which are already associated with increased risks of miscarriage, preterm birth, gestational diabetes, and preeclampsia. It noted that while reducing body weight before pregnancy could mitigate some risks, discontinuing GLP-1 medications may lead to weight regain. This regain might coincide with the early stages of pregnancy, complicating health outcomes.

The editorial also pointed out that semaglutide has a long half-life, meaning the drug remains in the body for several weeks, reinforcing guidelines that recommend stopping the medication at least two months before attempting to conceive. The authors advised that more research is necessary to better manage patients who discontinue these medications and to evaluate the balance of benefits and risks for those planning a pregnancy.

The study does have limitations, including the inability to confirm how consistently patients adhered to their medication regimen. Researchers matched participants based on their pre-pregnancy body mass index (BMI) rather than their BMI prior to starting GLP-1 treatment. Further studies are needed to determine the optimal timing for discontinuing GLP-1 drugs and to fully understand the long-term effects on both mothers and infants.