HUNTINGTON, W.Va. – As the use of GLP-1 and other incretin-based medications for obesity continues to grow worldwide, researchers at Marshall University have contributed to an international effort to address one of medicine's most pressing unanswered questions: How should these medications be used by women before, during and after pregnancy?

A new international review and consensus guideline published in Obesity Reviews provides the first comprehensive clinical recommendations for the use of incretin-based medications across the reproductive lifespan. Developed by experts from Europe, North America and the Middle East, the review systematically evaluated the available evidence and established practical guidance for clinicians caring for women of reproductive age.

Dr. Shahrad Taheri, professor and vice dean for adiposity-based chronic diseases at the Marshall University Joan C. Edwards School of Medicine, was the only U.S.-based contributor among the international authors involved in the project, a multidisciplinary collaboration spanning 23 institutions. The publication identifies critical knowledge gaps and offers practical recommendations for contraception, preconception care, pregnancy, breastfeeding and postpartum management.

"The rapid adoption of GLP-1 medications has outpaced the evidence available for women who are planning pregnancy or become pregnant," Taheri said. "This work provides clinicians with up-to-date, evidence-informed guidance while highlighting urgent research priorities needed to ensure these therapies can be used as safely and effectively as possible in women of reproductive age."

The review analyzed 34 studies (including randomized clinical trials, observational studies, pharmacovigilance analyses and case reports) to address key questions related to fertility, pregnancy outcomes, breastfeeding and postpartum health. Although the available evidence did not identify an increased risk of major congenital anomalies following inadvertent early pregnancy exposure, the authors emphasize that substantial evidence gaps remain, particularly regarding long-term maternal and child outcomes. 

The researchers also found that incretin-based medications may improve fertility-related outcomes in women with polycystic ovary syndrome (PCOS), recently renamed polyendocrine metabolic ovarian syndrome (PMOS), and obesity before pregnancy. However, current evidence remains insufficient to support their use during pregnancy or breastfeeding, underscoring the importance of careful contraceptive counseling and individualized clinical decision-making.

"This work represents an important step toward improving reproductive care for women living with obesity," Taheri said. “As the use of these medications continues to grow, this guidance provides a foundation for clinicians and identifies important opportunities for future research. We look forward to advancing that work and supporting the health of women in West Virginia and beyond.”

The authors conclude that nearly half of the clinically important questions surrounding incretin-based medications and reproductive health remain unanswered, reinforcing the need for prospective research studies and long-term follow-up to guide future clinical practice.

Published in Obesity Reviews, the official journal of the World Obesity Federation, the open-access article provides an important evidence base for healthcare professionals, researchers and policymakers as the use of incretin-based medications continues to expand worldwide.

To read the article its entirety, visit doi.org/10.1111/obr.70203.