DOI: 10.1177/15409996261478007 ISSN: 1540-9996

Glucagon-Like Peptide-1 Receptor Agonists Use Among Reproductive-Aged Women with Type 2 Diabetes

Stacy C. Bailey, Natalie A. Cameron, Stephanie Batio, Guisselle Wismer, Michael S. Wolf, Amisha Wallia, Jacob M. Schauer, Jena Wallander Gemkow, Alice Eggleston, Sandi Tenfelde, David M. Liebovitz, William A. Grobman, Sadiya S. Khan

Background:

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer important cardiovascular-kidney-metabolic benefits to women with type 2 diabetes (T2D) but are contraindicated during pregnancy. We sought to describe the frequency of GLP-1 RA prescribing among young women with T2D and to examine pregnancy intention, contraceptive use, and receipt of reproductive health counseling in this population.

Methods:

A total of 382 English- and Spanish-speaking women with T2D, aged 18–44, were recruited from 38 health centers in Chicago. Patients were enrolled in the usual care arm of an ongoing clinical trial testing a preconception health intervention. GLP-1 RA prescribing was determined via self-report with chart verification. Bilingual research coordinators administered structured surveys measuring pregnancy intention, contraceptive use, and receipt of reproductive health counseling.

Results:

Participants were sociodemographically diverse; 42.5% had a household income less than $35,000/year, 46% had limited health literacy, and the average age was 36 years. Half (50.8%) were prescribed a GLP-1 RA. Among women prescribed GLP-1 RAs ( n = 194), 54.6% intended a future pregnancy; 40.7% used hormonal contraceptives or an intrauterine device. Few reported discussing pregnancy intention (11.9%), contraceptive use (11.4%), or preconception health (13.4%) during their recent visit. Women with limited health literacy were less likely to report discussing preconception health (6.3%, 95% confidence interval [CI]: 1.4–11.2 versus 18.4%, 95% CI: 12.0–24.9, p = 0.01).

Conclusion:

GLP-1 RAs are commonly prescribed to young women with T2D, many of whom intend a future pregnancy, yet reproductive health counseling is scarce. Optimizing preconception care is critical to improve outcomes, particularly for women with limited health literacy.

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