(1135) Risk of Hypertensive Disorders of Pregnancy in GLP-1 Agonist Exposed and Unexposed Patients

To understand the effect of GLP-1 agonist use in the year prior to conception on risk of developing hypertensive disorders of pregnancy (HDP).

Study Design:

All patients delivering between 2014-2024 with evidence of GLP-1 exposure in the year prior to conception were identified through electronic medical record (EMR) query with hand review to confirm exposure.  GLP-1 exposed patients were classified according to GLP-1 indication for use: 1) pregestational diabetes mellitus (PGDM) or 2) weight management (WM) for increased body mass index (BMI). Control groups for each indication cohort were identified from 2021-2022 delivery EMR data. PGDM controls were patients with pregestational DM1 or DM2 managed with medication other than GLP-1 agonist in the year prior to conception. WM controls were a stratified random sample of patients without PGDM not on antihyperglycemic medication in the year prior to conception with BMIs between 30 < 40 kg/m² (n=100) and ≥40 kg/m² (n=100). Demographic and clinical characteristics and obstetrical outcomes were compared. Logistic regression was employed to assess the crude (OR) and adjusted odds ratios (aOR) for HDP controlling for covariates significant in bivariate tests at < 0.05.

Results:

246 patients had GLP-1 exposure in the year prior to conception. Of these, 104 were exposed for PGDM and 142 for WM. For the PGDM cohort, 175 controls were identified from the two years of EMR data interrogated. For the WM cohort, random sampling yielded 200 controls.

Bivariate tests for race/ethnicity, pre-pregnancy BMI, and chronic hypertension identified significant differences between exposed and unexposed patients in the PGDM cohort. For the WM cohort, exposed and unexposed patients had significant differences in PCOS diagnosis, gestational weight gain, and HDP. For both the PGDM and WM cohort, exposed patients were half as likely to develop HDP compared to unexposed counterparts (PGDM aOR =0.47 (0.27-0.83); WM aOR =0.48 (0.29-0.80)).

Conclusion:

GLP-1 use in the year prior to conception significantly reduced the likelihood of developing HDP for patients with PGDM and undergoing WM.