妊娠期GLP-1受体激动剂暴露：围孕期用药与围产结局

原文

ABSTRACT Objective An increasing number of women of childbearing age worldwide are using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and are advised to use effective contraception during treatment. Nevertheless, maternity services are encountering increasing numbers of women exposed to GLP-1 RAs shortly before conception or during pregnancy. The true extent of exposure is likely underestimated because routine enquiry is not universal. The effects of GLP-1 RA exposure on pregnancy remain poorly understood, and there is currently limited guidance on counselling women with inadvertent periconceptional exposure. Design Narrative review. Population or Sample Original research articles, systematic reviews and meta-analyses published in English from inception to 2026 were considered for inclusion. Methods A non-systematic literature search of PubMed, Google Scholar, MEDLINE and Embase was undertaken. Evidence relating to GLP-1 RA use from preconception through pregnancy and the postnatal period was reviewed. Main Outcome Measures Key findings relating to preclinical safety data, human pregnancy outcomes—including congenital anomalies, hypertensive disorders of pregnancy, gestational diabetes, preterm birth, fetal growth and stillbirth; pharmacokinetic and drug washout considerations. Results GLP-1 RAs improve weight and metabolic parameters and may improve fertility outcomes in selected populations, including women with obesity and polycystic metabolic ovarian syndrome (PMOS). Available human observational data have not demonstrated a clear increase in adverse pregnancy outcomes following periconceptional exposure. However, the evidence base is limited by small numbers, observational study designs, potential confounding and incomplete ascertainment of exposure and outcomes. Conclusions Current observational data have not identified a clear safety signal associated with inadvertent periconceptional exposure to GLP-1 RAs. However, robust pregnancy safety data remain limited and are insufficient to exclude clinically important risks. Further prospective data and consistent reporting of pregnancy exposures are needed. In the meantime, women with inadvertent exposure should receive individualised counselling based on the available evidence rather than assuming that exposure is either established to be harmful or proven to be safe.