Human pregnancy outcomes after early glucagon-like peptide-1 receptor agonist exposure: A scoping review

Table 4 Diabetes-specific comparative cohort and registry studies

Ref.	Country/design	Exposed population	GLP-1RA	Exposure window/cessation timing	Comparator	Maternal outcomes	Fetal/neonatal outcomes	Strength	Limitation	Interpretation
Chou et al[26], 2026	Taiwan (China); T2D cohort	160 T2D; 19 obese among exposed	Not specified	90 days before through 90 days after LMP	606 PM T2D cohort on insulin	Preterm 34.6% vs 31.9%; P = NS	MCM: 0.6% vs 0.2%; stillbirth: 4.4% vs 2.1%; SGA: 2.6% vs 3%; all P = NS	Diabetes-specific active comparator; PM T2D cohort	Small exposed sample; agent unspecified; limited power for rare anomalies	Reassuring; risk not greater than insulin-exposed T2D pregnancies
Cesta et al[27], 2024	Nordic countries/United States/Israel; T2D cohort	938 T2D; 483 obese among exposed	Not specified	180-365 days before LMP to end of first trimester (90-97 days)	5078 T2D on insulin	NR	MCM: 8.2% vs 7.8%; cardiac anomalies: 3.2% vs 4.2%; all P = NS. First-trimester GLP-1RA: MCM: 6.7% vs 7.8%; cardiac anomalies: 1.6% vs 4.2%. All P = NS	Large multinational population-based dataset; clinically relevant diabetic comparator	Prescription-based exposure; limited glycemic/BMI details; maternal outcomes not central	Reassuring for major teratogenicity compared with insulin-treated diabetes
Hanif et al[28], 2025	United States; T2D cohort	1826 T2D	Not specified	1 year before to 1 month after first trimester pregnancy diagnosis	1826 T2D unexposed to GLP-1RA (mostly LSM and/or insulin)	Maternal all-cause mortality, gestational HTN, preeclampsia/eclampsia: All P = NS	Cardiac anomaly, kidney anomaly: All P = NS	Large PM T2D cohort	Fetal assessment limited to cardiac and kidney anomalies. Agent unspecified; broad exposure window; residual confounding	Reassuring; no increased risk compared with T2D controls
Lewin et al[29], 2026	United States; T2D cohort, 3-year data	35083 DM; (T2D: 34343; T1D: 740)	Not specified	Any time during pregnancy for any duration	108510 DM; (T2D: 98628; T1D: 9882) not on GLP-1RA	PET 13.1% vs 11.9%, P < 0.0001; preterm 23.1% vs 20.8%, P < 0.0001; CD: 44.4% vs 38.9%, P < 0.0001	First-trimester abortion/termination 9.8% vs 7.5%, P < 0.0001; MCM: 3.3% vs 3.3%, P = 0.63; genital malformations: 0.7% vs 0.6%, P = 0.02; urinary malformations: 0.5% vs 0.4%, P = 0.01	Very large sample; able to detect rare system-specific signals	More severe baseline cohort; possible T1D admixture; strong confounding by disease severity; broad exposure definition	Reassuring for overall MCM but signals for PET, preterm, cesarean, abortion/termination, genital and urinary anomalies require cautious evaluation

Detailed Joanna Briggs Institute domain-level appraisal of the cohort, registry, and controlled human studies is provided in Supplementary Table 4. BMI: Body mass index; CD: Cesarean delivery; DM: Diabetes mellitus; GLP-1RA: Glucagon-like peptide-1 receptor agonist; HTN: Hypertension; LMP: Last menstrual period; LSM: Lifestyle modification; MCM: Major congenital malformation; NR: Not reported/not retrievable; NS: Not significant; PET: Preeclampsia; PM: Propensity-matched; SGA: Small for gestational age; T1D: Type 1 diabetes; T2D: Type 2 diabetes.