What obgyns need to know about GLP-1 receptor agonists.
This narrative review, aimed at obstetricians and gynecologists, synthesizes current evidence on GLP-1 receptor agonists (e.g., semaglutide) and dual GLP-1/GIP agonists (e.g., tirzepatide) as they relate to women's health. The authors highlight that phase 3 trials have reported 15–21% body weight reduction with these agents, with tirzepatide showing greater efficacy than semaglutide. In women with polycystic ovary syndrome (PCOS), the authors cite meta-analyses finding improvements in insulin resistance, androgen levels, and ovulation rates. Regarding contraception, the review notes that tirzepatide's gastric-emptying delay has prompted manufacturer guidance about backup contraception around initiation and dose escalation. On pregnancy safety, the authors describe emerging human cohort data suggesting no significantly increased risk of major congenital malformations from inadvertent early pregnancy exposure, while noting that animal teratogenicity data still warrant caution. Perioperative guidance has shifted toward individualized risk-stratified approaches rather than blanket discontinuation. The authors call for formal pregnancy registries to address persistent knowledge gaps. As a review, this paper does not generate new primary data, and its conclusions are limited by the underlying evidence base, which in several areas remains preliminary or indirect.
Why this grade: This is a narrative review that synthesizes existing trials, meta-analyses, and cohort studies rather than generating new primary data, so it receives a "review" evidence grade rather than a direct human-evidence rating.
Purpose of review Obstetricians and gynecologists increasingly encounter patients using glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide agonists. This review synthesizes evidence on these agents, focusing on their relevance in women's health. Recent findings GLP-1 receptor agonists and dual agonists achieve 15-21% body weight reduction in phase 3 trials, with tirzepatide demonstrating superior efficacy compared to semaglutide. Key populations of interest include patients with polycystic ovary syndrome (PCOS), pregnant patients, and those undergoing gynecologic surgery. In women with PCOS, meta-analyses confirm improvements in insulin resistance, androgen levels, and ovulation rates. Tirzepatide significantly delays gastric emptying, prompting manufacturer guidance to use backup contraception for 4 weeks after initiation or dose escalation. Emerging human cohort studies of inadvertent early pregnancy exposure report no increased risk of major congenital malformations, providing preliminary reassurance despite animal teratogenicity data. Perioperative guidance has evolved from blanket discontinuation to individualized, risk-stratified approaches. Summary GLP-1 receptor agonists offer benefits across the lifespan, with promising applications in PCOS and preconception optimization. Reproductive-aged women need counseling regarding contraception and preconception discontinuation. Knowledge gaps include the need for pregnancy registries. Obstetrician-gynecologists will increasingly encounter these therapies and must navigate evolving evidence regarding their safety, efficacy, and clinical implications.
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