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Key Takeaway
Interpret the null association between GLP-1 RA exposure and HDP risk cautiously due to limited evidence.
This is a meta-analysis of observational cohort studies evaluating the association between periconceptional or first-trimester exposure to GLP-1 receptor agonists (GLP-1 RAs) and the risk of hypertensive disorders of pregnancy (HDP). The analysis included 10,880 pregnancies from the United States, with 4,942 exposed to GLP-1 RAs (including semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, and albiglutide) and 5,938 unexposed pregnancies.
The pooled analysis found no statistically significant association between GLP-1 RA exposure and HDP risk (OR 0.91, 95% CI 0.57-1.47). The point estimate suggests a possible lower risk, but the confidence interval is wide and includes the null, indicating substantial uncertainty.
The authors note that the evidence is limited, and they call for large prospective studies to confirm these findings. Because the underlying studies are observational, the results reflect association only and cannot establish causality.
For clinicians, these findings suggest that periconceptional or first-trimester GLP-1 RA exposure is not significantly associated with HDP risk in this pooled analysis. However, given the observational nature and limited evidence, decisions about GLP-1 RA use in pregnancy should continue to follow current guidelines and individualized risk-benefit assessment.
How this fits prior evidence
This meta-analysis extends prior coverage on GLP-1 receptor agonists in type 2 diabetes by addressing a pregnancy-specific outcome. While prior coverage noted comparable MACE reduction for SGLT2 inhibitors and GLP-1 RAs in non-pregnant patients, this analysis focuses on a different safety endpoint. The null association for hypertensive disorders of pregnancy aligns with the overall null finding for OSAS and diabetic retinopathy, where subgroup signals were present. It also complements the proposed MASLD/MASH assessment pathway and metabolic surgery framework by providing data on a medication class commonly used in T2DM and obesity.
Researchers analyzed data from 10,880 pregnancies to see if certain medications, known as GLP-1 receptor agonists, were linked to hypertensive disorders of pregnancy. These medications include common drugs like semaglutide and tirzepatide, which are often used for weight management and type 2 diabetes.
The study looked at women who took these medications before becoming pregnant or during the first trimester. The results showed no statistically significant link between using these drugs and developing high blood pressure issues during pregnancy. While the data suggested a slightly lower risk in some cases, the difference was not large enough to be certain.
Because this was an observational study based on past records, the evidence is currently limited. More large, forward-looking studies are needed to confirm these findings. Patients should discuss their specific medical history and any medication use with their doctor before planning a pregnancy.
What this means for you:
Current data shows no significant link between GLP-1 medications and high blood pressure during early pregnancy.
Common questions
Are GLP-1 medications safe for women trying to get pregnant?
This study of 10,880 pregnancies found no statistically significant link between GLP-1 receptor agonists and hypertensive disorders of pregnancy. However, because the evidence is limited and based on observational data, you should talk to your doctor about your specific health needs before making any changes.
Which specific medications were studied regarding pregnancy risk?
The study included several GLP-1 receptor agonists, including semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, and albiglutide. The researchers looked at these medications when taken before conception or during the first trimester of pregnancy.
Does this study prove that GLP-1 drugs are safe for pregnancy?
The study shows a link but does not prove cause and effect. Because it was an observational meta-analysis with limited evidence, more large prospective studies are needed to confirm the findings before they can be used to change standard medical practice.
PURPOSE: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), used to treat type 2 diabetes and obesity, may improve metabolic health before conception. However, their association to hypertensive disorders of pregnancy (HDP) after periconceptional or early pregnancy exposure remains unknown.
METHODS: We performed a meta-analysis to investigating association between GLP-1 RAs preconception or first trimester of gestation exposure and HDP risk. Cochrane Central Register of Controlled Trials databases, ClinicalTrials.gov, PubMed, Scopus, and EMBASE databases were searched from inception through December 15, 2025. All eligible studies were observational cohorts. Case reports, reviews, editorials, and studies that lacked HDP data were excluded. We pooled odds ratios with 95% confidence intervals using a random-effects Mantel-Haenszel model. ROBINS-I tool was used to evaluate risk of bias.
RESULTS: Of 75 records identified, 3 retrospective cohort studies met inclusion criteria with 10,880 pregnancies (4942 exposed to GLP-1 RAs and 5938 unexposed). All the studies were conducted in the United States between 2014-2025 and evaluated the semaglutide, liraglutide, dulaglutide, tirzepatide, exenatide, lixisenatide, and albiglutide exposure. Two studies showed a lower HDP risks among exposed pregnant, whereas one study found a higher risk. In the pooled analysis, GLP-1 RA exposure showed a HDP risk with an OR 0.91 (OR 0.91, CI 0.57-1.47) with no statistical significance.
CONCLUSION: Periconceptional or first-trimester exposure to GLP-1 RAs are not significantly associated with HDP risk. This available evidence is limited and indicating the need for large prospective studies to establish a possible association between GLP-1 RAs are not significantly associated with HDP risk.
