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

Table 5 Obesity-, polycystic ovary syndrome-, and fertility-focused cohorts and registry studies

Ref.	Country/design	Exposed population	GLP-1RA	Exposure window/cessation timing	Comparator	Maternal outcomes	Fetal/neonatal outcomes	Strength	Limitation	Interpretation
Bolek et al[30], 2026	Slovakia; prospective cohort	20 obese + PCOS + prediabetes	Semaglutide	Stopped ≥ 30 days before pregnancy	NR	Live birth 12/20 (60%); no reported maternal complication	Eutrophic neonates	Prospective; semaglutide-specific	Very small; no comparator; preconception discontinuation	Reassuring but not informative for continued pregnancy exposure
Bartelt et al[33], 2024	United States; retrospective cohort, 7-year data	1208 obese	Not specified	90 days before conception to during pregnancy	Unexposed general population, n = 775478	Preterm birth signal: 13% vs 10%	Higher NICU admission: 12% vs 8%	Large real-world cohort	General population comparator; high risk of confounding by obesity/metabolic disease	Not reassuring with general comparator. CHD and failure-to-thrive rates were similar by exposure timing; needs obesity-matched controls
Guo et al[31], 2025	China; retrospective obese non-T2D cohort	20 obese after exclusion of T2D	Semaglutide, titrated up to 2.4 mg/week	Used for 6 months; stopped 2 months before conception	22 obese treated with LSM	GDM 20% vs 31.8%; CD similar; GWG: 9.16 kg vs 17.7 kg, P < 0.05	No MCM; no NICU admission; no neonatal hypoglycemia; similar birth weight	Obesity comparator; T2D excluded; dose specified	Very small human study; preconception exposure only. Mostly animal/mechanistic emphasized study	Suggests improved GWG and GDM after preconception semaglutide; reassuring but underpowered
Li et al[32], 2022	China; controlled preconception PCOS study	57 overweight/obese, infertility, PCOS	Exenatide	12-week pregestational exenatide	Obese PCOS/prediabetes; n = 60 on metformin	Spontaneous pregnancy rate by week 24: 29.2% vs 14.7%; total pregnancy by week 64: 79.2% vs 76%; pregnancy outcomes not significantly different	Miscarriage, live birth, preterm birth, GDM, gestational hypertension, macrosomia and birthweight not significantly different; one ASD reported in exenatide arm	Active comparator; preconception fertility context	Not designed as pregnancy-safety study; GLP-1RA was not continued as assigned therapy during organogenesis; metformin co-use and fertility-care surveillance confound interpretation	Early reassuring signal for preconception exenatide in PCOS

Detailed Joanna Briggs Institute domain-level appraisal of the cohort, registry, and controlled human studies is provided in Supplementary Table 4. ASD: Atrial septal defect; CD: Cesarean delivery; CHD: Congenital heart disease; GDM: Gestational diabetes mellitus; GLP-1RA: Glucagon-like peptide-1 receptor agonist; GWG: Gestational weight gain; LSM: Lifestyle modification; MCM: Major congenital malformation; NICU: Neonatal intensive care unit; NR: Not reported/not retrievable; PCOS: Polycystic ovary syndrome; T2D: Type 2 diabetes.