Pregnant Patients With T2D See Pluses and Minuses With Semaglutide

AURORA, Colo. — Pregnant patients with type 2 diabetes (T2D) treated with semaglutide (Ozempic) had mixed pregnancy outcomes, an observational study found.

Among more than 4 million pregnancies, patients exposed to semaglutide were 26% less likely than controls to deliver preterm with an adjusted OR (aOR) 0.74 (95% CI 0.67-0.81, P<0.001), reported Emily Adams, MD, of Johns Hopkins University School of Medicine in Baltimore, in a poster presentation at the Society for Maternal-Fetal Medicine annual meeting.

However this group was significantly more likely to develop other adverse pregnancy outcomes:

• Preeclampsia: aOR 1.16 (95% CI 1.11-1.23, P<0.001)
• Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: aOR 1.88 (95% CI 1.38-2.56, P<0.001)
• Eclampsia: aOR 2.74 (95% CI 2.17-3.47, P<0.001)

“From what we could tell, even for controlling for other very important factors, like pregestational diabetes, obesity, and chronic hypertension, we saw that in our patient population, there was an overall decreased odds of preterm birth in the semaglutide-exposed population, and an increased odds of preeclampsia, eclampsia, and HELLP syndrome,” Adams told MedPage Today.

Patients with T2D are at higher risk for adverse pregnancy outcomes like preeclampsia, preterm birth, and neonatal complications. GLP-1 receptor agonists such as semaglutide, which are effective drugs for managing hyperglycemia in T2D, are often discontinued in pregnancy because of a lack of safety and efficacy data.

“We wanted to look at — because there’s an overall vacuum of data — the pregnancy outcomes, both maternal and fetal, when patients are exposed to semaglutide in pregnancy,” Adams said. “It’s a very hot button topic right now, the use of GLP-1 agonists in pregnancy, because of how often they’re being used outside of pregnancy, both for improved glucose control and also for weight loss.”

Study co-author Ahizechukwu Eke, MD, PhD, MPH, also of Johns Hopkins, pointed out that people with pregestational diabetes already have vascular complications.

“So seeing high levels of preeclampsia, eclampsia, and all that in these women may be due to…confounding by indication, which is difficult to control for,” Eke told MedPage Today.

Eke said he thinks other research should look into pregnancy outcomes for people who take semaglutide for weight loss rather than diabetes to see if the results are different.

Adams noted that pregnant patients with T2D who are taking GLP-1 agonists are often pleased with their results, and don’t necessarily want to discontinue use.

“Unfortunately in pregnancy, there is such a paucity of information as it relates to new pharmacologic agents. We are lacking prospective studies and randomized control trials,” Adams said. “I think we owe those patients further research that is not just these bird’s-eye view studies, but it’s very granular in terms of duration exposure and maternal and fetal outcomes.”

The current multicenter observational cohort consisted of pregnant individuals with T2D who delivered from January 2021-April 2024. The study took place at 192 hospitals in 38 states. Data were sourced from the Vizient Clinical Database. In total, the cohort had about 4.6 million pregnancies, of which 0.2% were exposed to semaglutide; 4.5 million patients were the controls. At study entry, mean maternal age was 29.5 for the semaglutide group and 30.3 for the control group. Most patients were Black.

Preterm birth was the primary outcome; secondary outcomes included hypertensive disorders, intrahepatic cholestasis, and neonatal outcomes.

Adams noted that the Vizient database did not reveal how long the semaglutide exposure took place among the study patients. It is likely that many of them discontinued semaglutide at some point during their pregnancy, which was a study limitation, she said.

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