2154-P: Second-Line Antidiabetic Exposure in Early Pregnancy and Risk of Spontaneous Abortion: A Nationwide Cohort Study

by sugaradmin



Introduction and Objective: Most second-line antidiabetic agents are contraindicated during pregnancy; however, unintended exposure during early gestation is common. We assessed the risk of spontaneous abortion (SAB) associated with the continued use of second-line antidiabetics during early pregnancy.Methods: Using the National Health Information Database of Korea from 2012 to 2023, we identified pregnant women with type 2 diabetes who were receiving SGLT2 inhibitors (SGLT2i), GLP-1 receptor agonists (GLP-1 RA), DPP-4 inhibitors (DPP4i), sulfonylureas (SU), or thiazolidinediones (TZD) within 180 days prior to their last menstrual period (LMP). For each drug class, we compared women who continued these medications with insulin versus a guideline-recommended comparator group switching to insulin monotherapy within the first 6 weeks of gestation. The outcome was SAB occurring up to 20 gestational weeks. Hazard ratios (HR) were estimated using inverse probability weighted Cox proportional hazards models to adjust for confounding, treating induced abortion as a competing risk.Results: The study included 12,146 pregnancies (mean age 36.3 years) with pre-pregnancy second-line antidiabetics use. The specific drug cohorts included users of SGLT2i (n=3,401), GLP-1 RA (n=492), DPP4i (n=7,373), SU (n=5,203), and TZD (n=1,141). Continued use of second-line antidiabetics was not associated with an increased risk of SAB compared to insulin monotherapy. The weighted HRs were 0.75 (95% CI 0.61-0.92) for SGLT2i, 0.86 (0.52-1.44) for GLP-1 RA, 0.89 (0.77-1.04) for DPP4i, 1.00 (0.84-1.19) for SU, and 0.90 (0.57-1.41) for TZD.Conclusion: In this nationwide cohort, exposure to second-line antidiabetic agents during early pregnancy was not associated with an increased risk of SAB compared to insulin monotherapy. These findings provide reassurance regarding the safety of unintentional exposure to these agents during early gestation.

Disclosure

Y. Cho: None. E. Choi: None. H. Ko: None. B. Hong: None. K. Jung: None. J. Shin: None.



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