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As prescriptions of GLP-1 receptor agonists for women increase, so to do the number of unexpected pregnancies, prompting calls for clearer prescribing guidelines.
The prescribing of GLP-1 receptor agonists for women of reproductive age is increasing in Australia, but new research, published in the Medical Journal of Australia, has found fewer than one in four women are using contraception at the time of treatment initiation.
The rise of GLP-1 receptor agonists prescriptions has been accompanied by a rise in unexpected pregnancies; a phenomenon that has been referred to as “Ozempic babies.”
Given concerns that the use of GLP-1 receptor agonists during pregnancy could be harmful, the researchers sought to determine whether contraception recommendations are being followed when prescribing the medication.
“GLP-1 receptor agonists can be highly effective treatments for women of reproductive age with diabetes and obesity, but concerns about their safety during pregnancy have been expressed,” Associate Professor Luke Grzeskowiak and co-authors wrote.
“Anecdotal reports of unplanned pregnancies in women using GLP-1 receptor agonists are nevertheless increasing, but robust data on their use, contraception use, and pregnancies among Australian women of reproductive age are not available.”
“We therefore investigated longitudinal changes in the initial prescribing of GLP-1 receptor agonists for women of reproductive age in Australia, analysing data from a large national general practice research database.”
Low rates of contraception a concern
The researchers found that prescribing of GLP-1 receptor agonists for women of reproductive age attending Australian general practices increased during 2015–2022, and particularly rapidly during 2020–2022.
Of the 18 010 women prescribed GLP-1 receptor agonists during 1 January 2011 – 31 July 2022, only 21.2% of these women were on concurrent contraception, and 2.2% were pregnant within six months of being prescribed GLP-1 receptor agonists.
“The low levels of highly effective contraception coverage among women commencing treatment with GLP-1 receptor agonist is concerning,” the authors wrote.
“The reasons for the low coverage level could be related to limited awareness of the risks associated with GLP-1 receptor agonist use during pregnancy, or perceptions of reduced fertility in women with type 2 diabetes, polycystic ovary syndrome, or obesity.”
“However, as modest reductions in weight can improve fertility, the risk of unintended pregnancy is significant if effective contraception is not used.”
Clearer practice recommendations needed
While recent studies have provided some reassurance about the safety of GLP-1 receptor agonists usage during pregnancy, the information is still limited.
“Given the metabolic programming effects of GLP-1 receptor agonists, safety concerns are not limited to the risk of major congenital malformations,” the authors wrote.
“Concerns about short and long term effects on fetal growth and metabolic health are related to reports of increased risk of small for gestational age babies among women who lose weight while pregnant, indicating that rapid weight loss itself, immediately prior to or during early pregnancy, might increase the risk of adverse pregnancy outcomes.”
The researchers argue further evidence and guidelines are needed to support the safe and effective use of GLP-1 receptor agonists by women of reproductive age.
“Given that GLP-1 receptor agonists are increasingly prescribed for off-label uses such as weight loss, as well as high rates of overweight and obesity among women of reproductive age, clinical practice guidelines are needed to support their safe and effective use in women in this age group,” they wrote.
“Clearer practice recommendations are not only needed for women with type 2 diabetes, but also for those with polycystic ovary syndrome or obesity, with appropriate emphasis on ensuring concurrent contraception.”
Read the research in the Medical Journal of Australia.
Annika Howells is the sub-editor of the MJA’s InSight+.
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