Key takeaways:
- GLP-1 RA prescribing rose from 0.2 to 6.4 per 1000 deliveries predelivery and from 0.3 to 14.6 per 1,000 postdelivery between 2019 and 2024, with accelerated growth beginning as early as March 2021.
- An estimated 20,000 pregnant individuals were exposed to GLP-1 medications in 2024 alone, a number investigators believe has continued to grow.
- Because many pregnancies are unplanned, inadvertent perinatal GLP-1 RA exposure is increasingly common, and robust safety and outcomes data are urgently needed.
Prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the perinatal period increased more than thirtyfold between 2019 and 2024, according to findings from a large retrospective cohort study using a national electronic health records database—a trend investigators say underscores an urgent need for safety data in pregnant and postpartum populations.
The study drew on the TriNetX database, a continuously updated repository of de-identified electronic health records from more than 100 million patients across US hospitals and health systems. Investigators identified patients aged 25 to 50 years who delivered between January 2019 and mid-2024, then examined semaglutide and tirzepatide prescriptions in the year before and after delivery.
"With this gigantic, national, almost real-time database, we have timely access to prescribing trends without waiting for long periods of time to get this type of data," said Kevin Y. Xu, MD, MPH, an assistant professor of psychiatry at Washington University in St. Louis.
Prescribing prevalence rose from 0.2 to 6.4 per 1000 deliveries in the predelivery period and from 0.3 to 14.6 per 1,000 deliveries postdelivery. Segmented linear regression with data-driven change-point detection identified accelerated prescribing beginning in June 2022 for the predelivery period and March 2021 for the postdelivery period.
Xu contextualized the magnitude of that shift. "This translates to roughly 20,000 pregnant people exposed to GLP-1 medication in 2024 alone," he said. "And we're already in 2026 now—so this data ended in 2024, so if I had to guess, we might be at an even larger number at this point."
The clinical backdrop driving the study reflects a common scenario on labor and delivery. "Patients come to us and say, 'I've been on this for the last year, I didn't plan on getting pregnant, but here I am—what are the risks?'" said Jeannie C. Kelly, MD, MS, division chief, Maternal-Fetal Medicine and Ultrasound Division, vice chair of Obstetrics, and an associate professor of obstetrics/gynecology at Washington University in St. Louis. "Right now, we have some answers to those questions, but a lot more work needs to be done."
Kelly noted that unplanned pregnancies make inadvertent GLP-1 RA exposure nearly inevitable at current prescribing volumes. "Many pregnancies happen without intending for a pregnancy to happen, and a lot of times there's inadvertent or unplanned medication exposure in those pregnancies," she said. "This is definitely one of those medications that we're seeing quite frequently now."
Although the study did not assess fetal or maternal outcomes, the rapid adoption of these agents—across insured and uninsured populations alike—establishes the scale of exposure that outcome studies will need to address.
"This work really is the start of that," Kelly said, "which is to just look at the prescribing trends around the time of pregnancy for us to understand how big this exposure is happening."
Reference:
1. Lessard C, Cary C, In A, et al. Prescribing Trends in glucagon-like peptide-1 medications among pregnant and postpartum persons. Obstet Gynecol. 2026;147(3):290-292. doi:10.1097/AOG.0000000000006161
