Use of Glucagon-Like Peptide-1 Receptor Agonists in Women with Type 2 Diabetes Before Pregnancy: Addressing the Dilemma in A Real-World Setting.
Glucagon-Like Peptide-1 receptor agonists (GLP-1RAs) are in the spotlight again—this time for their use in women with type 2 diabetes who might become pregnant. Danish researchers just took a hard look at what actually happens when these research peptides are used before and during early pregnancy. The old story was simple: animal studies suggested risk, so most experts played it safe and told women to stop GLP-1RAs months before trying for a baby. But the new human data tells a different story.
Curr Diab Rep
by Amiri A, Hædersdal S, Damm P et al.
“Use of Glucagon-Like Peptide-1 Receptor Agonists in Women with Type 2 Diabetes Before Pregnancy: Addressing the Dilemma in A Real-World Setting. Amiri A(1)(2), Hædersdal S(1)(3)(4), Damm P(2)(3)(5), Mathiesen ER(1)(2)(3), Ringholm L(6)(7)(8). Author information: (1)Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. (2)Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. (3)Center for Pregnant Women with Diabetes, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. (4)Department of Clinical and Translational Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, DK-2730, Denmark. (5)Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. (6)Department of Nephrology and Endocrinology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. lene.ringholm.02@regionh.dk. (7)Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. lene.ringholm.02@regionh.dk. (8)Center for Pregnant Women with Diabetes, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, DK-2100, Denmark. lene.ringholm.02@regionh.dk. PURPOSE OF REVIEW: To address the clinical dilemma of how best to counsel women with type 2 diabetes (T2D) using glucagon-like peptide-1 receptor agonists (GLP-1RA) regarding pregnancy. RECENT FINDINGS: Animal studies raise concern for fetal loss, malformations and adverse fetal growth after GLP-1RA exposure. Nonetheless, three cohort studies and one prospective study including 2,994 women with T2D exposed to GLP-1RA in early pregnancy indicate no increased risk of malformations compared with unexposed pregnancies, and observational data in 168 GLP-1RA exposed pregnancies are reassuring regarding miscarriage and fetal growth. Women with T2D are advised to use contraception and to discontinue GLP-1RAs two months before planned pregnancy. Despite concerns in animal studies, GLP-1RA exposure in early T2D pregnancy has not been associated with increased risk of malformations. If a woman with T2D inadvertently becomes pregnant while using GLP-1RA, the existing human evidence does not support a recommendation of terminating pregnancy. © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. Conflict of interest statement: Declarations. Human/Animal Studies Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. Competing interests: LR has received a grant from Novo Nordisk Foundation (grant number: NNF24OC0091713) for an investigator sponsored randomized controlled trial for which Mylife Diabetes Care AG donates insulin pumps and accessories and Abbott donates continued glucose monitoring devices, and participated in the European Association for the Study of Diabetes annual meeting 2023 as an invite by Novo Nordisk. SH has received funding from Independent Research Fund Denmark, Novo Nordisk and Boehringer Ingelheim. PD has participated in clinical studies on the use of insulin in pregnant women with preexisting diabetes in collaboration with Novo Nordisk, but no personal honorarium was involved. AA and ERM declare no competing interests.”
Here’s the punchline: Real-world studies involving almost 3,000 women with type 2 diabetes exposed to GLP-1RAs in early pregnancy found no increased risk of malformations or adverse fetal growth. Observational data on another 168 pregnancies supported this—no uptick in miscarriage or fetal growth problems. That’s a big deal for researchers interested in GLP-1RA safety and peptide research for metabolic health.
Key takeaway: If a woman with type 2 diabetes gets pregnant while using GLP-1RA by accident, the data does not back up a need to terminate the pregnancy due to peptide exposure. That’s a major shift from the anxiety fueled by animal data. The human evidence just isn’t showing increased harm.
For researchers:
The gap between animal models and real-world human outcomes is clear here.
There’s still a standard protocol—discontinue GLP-1RAs two months before planned pregnancy—but the evidence base is evolving.
GLP-1RAs remain a hot topic in metabolic peptide research, especially around safety and reproductive health.
Want more on where GLP-1RAs fit in the bigger picture? Start at the peptide research index for context and links to current studies.
The verdict: Real-world research is raising confidence in GLP-1RA safety for women with type 2 diabetes, at least when accidental early exposure occurs. This is a win for clarity—and for anyone tracking the science behind peptide safety.
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