Prepregnancy GLP-1 exposure and potential gestational weight gain associations with Nishita Pondugula, MD, MS

Peripregnancy exposure to glucagon-like peptide-1 receptor agonists (GLP-1RAs) was not associated with hypertensive disorders of pregnancy (HDP) but was linked to decreased odds of gestational weight gain below recommendations in patients using the medication for weight management, according to an abstract presented at the 2026 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting and published in the March 2026 edition of Obstetrics & Gynecology.

Nishita Pondugula, MD, MS, Obstetrics and Gynecology Residency, Duke University Medical Center, and lead author, summarized the retrospective cohort findings.

"We found that there was a significant decreased risk of having gestational weight gain below the Institute of Medicine recommendations during pregnancy with GLP-1 exposure, especially in early pregnancy, and our study did not find any association between pre-pregnancy or early pregnancy GLP-1 exposure and hypertensive disorders of pregnancy," she said.

GLP-1s and associated gestational weight gain, hypertensive pregnancy disorders

The study included 243 patients exposed to a GLP-1RA up to 1 year before pregnancy, 65.4% of whom had evidence of use during pregnancy. Per the abstract, exposure was associated with decreased odds of below-recommended gestational weight gain in the weight-management cohort (aOR 0.37; 95% CI, 0.18–0.78), but was not associated with gestational weight gain in the pregestational diabetes cohort. GLP-1RA exposure was not associated with HDP in either the pregestational diabetes (aOR 0.72; 95% CI, 0.42–1.25) or weight-management (aOR 0.83; 95% CI, 0.45–1.52) cohorts.

Pondugula interpreted the weight-gain finding as likely reflecting rebound weight gain after cessation. "Big picture this suggests rebound weight gain, and that is consistent with studies outside of pregnancy that show that rebound weight gain is common, up to two thirds of the original weight loss within the first year after discontinuation of the GLP-1, with the most rapid weight regain right after medication cessation," she said.

Future studies of GLP-1s in pregnancy

Pondugula noted the study offers early reference for clinicians managing incidental exposure, while emphasizing its limitations.

"This is a small study, and we need additional larger studies to help guide us, but this is just one of the early things that clinicians can rely on when they see a patient who has already been started on a GLP-1 and is now pregnant," she said. "For the vast majority of patients [the recommendation] is still to discontinue the GLP-1 agonist prior to conception," she said, noting that patients who newly discover pregnancy while taking a GLP-1RA should stop for the remainder of pregnancy.

Pondugula said additional research is needed, particularly in patients with severe, poorly managed diabetes, for whom benefits may potentially offset risks.

Reference:

Pondugula N, Culhane J, Lundsberg L, et al. Gestational Weight Gain and Hypertensive Disorders of Pregnancy With Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure. Obstetrics & Gynecology. March 2026. Accessed June 24, 2026. doi:10.1097/AOG.0000000000005995