Invited Speaker Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2024

Considering the place of incretin analogues in the management of obesity prior to pregnancy (108308)

Sarah Price 1
  1. University of Melbourne, Heidelberg Heights, VIC, Australia

Almost all international guidelines recommend women with obesity should pursue weight management with lifestyle modification prior to pregnancy (1). Despite these guidelines, the demand for incretin analogues in women with obesity planning pregnancy is overwhelming. This is likely driven by (i) the compelling evidence that obesity can adversely impact fertility and pregnancy outcomes, including offspring being born with congenital anomalies, prematurity-related comorbidities, and a long-term predisposition to metabolic disease; and (ii) assisted reproductive guidelines which prevent access to assisted fertility (i.e. in vitro fertilization) in women with BMI >40kg/m2 (2).

Based on data from animal studies, incretin analogues are Therapeutic Goods Administration (TGA) pregnancy Class D (drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage)(3). Reassuringly, the available human data about the offspring of women inadvertently exposed to incretin analogues during the first trimester of pregnancy indicates no increase in the rate of congenital anomalies (4).

This talk will explore the available evidence about the use of incretin analogues in women with obesity who are planning pregnancy. It will also explore areas where evidence is lacking, such as the amount of weight loss that may be required to improve pregnancy outcomes, the ideal time to cease incretin analogues drugs prior to conception, and the potential implications of these drugs on gestational weight gain, appetite regulation and pregnancy outcomes. Based on the available evidence and clinical consensus, the talk will outline a pragmatic approach for the management of women who elect to use incretin analogues prior to conception.  

  1. Giouleka S, Tsakiridis I, Koutsouki G, Kostakis N, Mamopoulos A, Kalogiannidis I, et al. Obesity in Pregnancy: A Comprehensive Review of Influential Guidelines. Obstet Gynecol Surv. 2023;78(1):50-68.
  2. Rozen G, Stern K, Lensen S, Polyakov A. Barriers to reproductive treatments in Australia. Aust J Gen Pract. 2023;52(3):109-12.
  3. Muller DRP, Stenvers DJ, Malekzadeh A, Holleman F, Painter RC, Siegelaar SE. Effects of GLP-1 agonists and SGLT2 inhibitors during pregnancy and lactation on offspring outcomes: a systematic review of the evidence. Front Endocrinol (Lausanne). 2023;14:1215356.
  4. Cesta CE, Rotem R, Bateman BT, Chodick G, Cohen JM, Furu K, et al. Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy. JAMA Intern Med. 2024;184(2):144-52.