Prenatal exposure to GLP-1 receptor agonists and other second-line antidiabetics may not pose greater risk than insulin

Infants born to girls with pre-gestational kind 2 diabetes who take second-line non-insulin antidiabetic drugs (ADMs) throughout being pregnant are at no larger danger of main congenital malformations (MCMs) than infants born to those that take insulin, in response to a brand new examine led by Harvard T.H. Chan College of Public Well being.

Whereas MCMs, together with main cardiac malformations, are extra prevalent amongst infants born to girls with pre-gestational diabetes, the researchers noticed no variations in danger between infants whose mom handled her diabetes with insulin versus with non-insulin second-line ADMs.

The examine additionally discovered a rise in use of second-line non-insulin ADMs all through the examine interval, particularly use of GLP-1 receptor agonists within the U.S., suggesting the variety of infants prenatally uncovered to those medication will proceed to extend.

The examine was printed in JAMA Inner Drugs. It’s the first giant examine to look at the potential dangers second-line non-insulin ADMs pose to fetal growth in people.

“As kind 2 diabetes turns into a extra widespread situation amongst girls of reproductive age, and with the current approval of GLP-1 receptor agonists similar to semaglutide to deal with weight problems, the variety of uncovered pregnancies is more likely to enhance. Our findings present preliminary reassurance of security for infants prenatally uncovered to those drugs,” mentioned first creator Carolyn Cesta, assistant professor at Karolinska Institutet in Sweden.

Utilizing well being databases in Finland, Iceland, Norway, Sweden, the USA, and Israel, the researchers examined the outcomes of greater than 3.5 million pregnancies between 2009 and 2021.

Amongst these pregnancies, 51,826 (1.5%) comprised the examine group of girls with pre-gestational kind 2 diabetes. Within the periconceptional interval—between three months earlier than and three months after conception—15,148 (29.2%) of those people crammed a prescription for a first- or second-line ADM.

The examine discovered that infants whose mom had pre-gestational kind 2 diabetes had a considerably larger prevalence of MCMs, together with cardiac malformations, in contrast with infants within the basic inhabitants.

Throughout the examine inhabitants of girls with kind 2 diabetes, 5.58% of infants had been born with an MCM and a pair of.25% had been born with a cardiac malformation, in comparison with 3.76% and 1.31%, respectively, of infants born to the final inhabitants. Nevertheless, inside infants born to girls with diabetes who took second-line non-insulin ADMs—sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors—the examine didn’t discover a better danger of MCMs after periconceptional publicity in contrast with infants uncovered to insulin.

The researchers famous that a number of the examine’s findings had been imprecise, and that steady monitoring and additional analysis will present extra exact danger estimates.

“As an increasing number of dad and mom and their well being care suppliers seek for proof on the security of those drugs, our analysis can assist inform their choices,” mentioned senior creator Sonia Hernández-Díaz, professor of epidemiology at Harvard Chan College.