Published online Oct 15, 2026. doi: 10.4239/wjd.124799
Revised: July 17, 2026
Accepted: August 28, 2026
Published online: October 15, 2026
Processing time: 110 Days and 11.8 Hours
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and related incretin-based dual agonists are increasingly used by women of reproductive age for type 2 diabetes, obesity, polycystic ovary syndrome, and infertility-related metabolic dysfunction. This expanding use has created a clinical dilemma about how to counsel women during periconception or inadvertent early-pregnancy exposure.
To map and critically synthesize the available human evidence on maternal, pregnancy, fetal, neonatal, and offspring outcomes following periconceptional or early-pregnancy GLP-1RA exposure.
We conducted a scoping review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, using PubMed and Google Scholar from January 1, 2000 to June 10, 2026. Evidence was organized by study design and inferential strength, including case reports; case series; pharmacovigilance analyses; regulatory clinical-trial pregnancy datasets; comparative cohort, registry, and controlled studies; and systematic reviews with meta-analyses. Systematic reviews without meta-analysis were retained only for contextualization and reference cross-checking. A Mea
Forty-seven reports were included, comprising 41 core evidence reports and 6 contextual systematic reviews without meta-analysis. Core evidence included 17 case reports, 3 case series, 1 pharmacovigilance study, 1 regulatory clinical-trial pregnancy dataset, 16 cohort studies, and 3 systematic reviews with meta-analyses. Across comparative cohorts and meta-analyses, inadvertent preconceptional or early-pregnancy GLP-1RA exposure was not associated with a consistent increase in overall major congenital malformations. However, signals for spontaneous abortion, elective termination, preeclampsia, preterm birth, altered gestational weight gain, fetal growth abnormalities, and renal/genitourinary anomalies were inconsistently reported. Interpretation was limited by confounding from type 2 diabetes, obesity, polycystic ovary syndrome, infertility, hypertension, nephropathy, comparator choice, exposure-window heterogeneity, and prescription-based exposure misclassification. Evidence was strongest for cautious reassurance after inadvertent exposure and weakest for planned or continued pregnancy use.
Current human evidence does not indicate a reproducible teratogenic signal after inadvertent preconceptional or early-pregnancy GLP-1RA exposure. Nevertheless, available data remain observational, heterogeneous, and confounded. GLP-1RAs should be discontinued when pregnancy is recognized, and women should be transitioned to pregnancy-compatible metabolic care. Planned or continued GLP-1RA use during pregnancy is not supported.
Core Tip: This scoping review maps the full human evidence spectrum on glucagon-like peptide-1 receptor agonist exposure before conception and during early pregnancy, from case reports to meta-analyses. The most important finding is cautiously reassuring: no consistent overall signal of major congenital malformations has emerged after inadvertent early exposure. However, pregnancy loss, termination, hypertensive disorders, preterm birth, fetal growth, and renal/genitourinary signals remain uncertain and highly confounded. Clinicians should reassure women after accidental exposure, stop glucagon-like peptide-1 receptor agonists once pregnancy is recognized, and avoid planned or continued use during pregnancy until stronger prospective evidence is available.