GLP-1 receptor agonists have become an important group of drugs used in the treatment of type 2 diabetes and then obesity. There are also many reports of very beneficial effects, e.g. in the treatment of polycystic ovary syndrome. Multidirectional metabolic impact, weight loss, menstrual regularity, and therefore fertility, when used in a group of young women, the possibility of pregnancy should always be taken. We present a case report of the patient which is the starting point for a review of the current state of the art, a review of the literature, and the proposed management of GLP-11 analogs treatment among women of reproductive age. A 43-year-old patient with type 2 diabetes treated with metformin and semaglutide in the fifth pregnancy, in the seventh week of pregnancy, came to a gynecologist and diabetologist, which meant several weeks of exposure to semaglutide in the first trimester of pregnancy. In the obstetric history 2 deliveries and 2 miscarriages, history of irregular menstruation. A patient with a diagnosis of diabetes in pregnancy during a second pregnancy, was treated with metformin after delivery, and then semaglutide was added. Semglutide for 6 months. The patient did not use oral contraception, because she planned the implantation of intrauterine device. Glycated hemoglobin was 5.4%. Semaglutide was discontinued and the patient quickly required the functional insulin therapy. The reference ultrasound examinations of the first and second trimesters did not reveal any fetal defects. In subsequent trimesters, HBA1c-5.25.4%. The girl The fetus was through a transverse incision in the lower uterine segment. The fetus was a female delivered at 35 gestational age, weighing 2750 g. GLP-1 agonists have been classified by the FDA and EMA as group C, which means that they are contraindicated during pregnancy. From preclinical studies, we know about skeletal defects in rodents and rabbits. There is a recommendation to use contraception in the pre-pregnancy women and a time of wash-out recommendation. For semglutide it is- 2 months. There are only single cases describing pregnancy during exposure to GLP-1RA. Most likely, in the coming years the data will be more accurate because the increasing use of GLP-1 receptor agonists in treatment provide data in cases of unplaned pregnancies. We will also need a long-term observation of those patients and their offspring.
13 May 2023 - 16 May 2023