Semaglutide

Small for gestational age (weight)

id	Study   Auto Kolding (Controls exposed to insulin), 2025Kolding (Controls unexposed, general pop), 2025Maya, 2025	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S18830 R80183	Kolding (Controls exposed to insulin), 2025	Small for gestational age (less 15% (10 p) of registered livebirths)	1st trimester	retrospective cohort	exposed to other treatment, sick excluded	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.40 [0.02;6.80] C excluded (control group)	0/29   21/514	21	29		ref
S18831 R80190	Kolding (Controls unexposed, general pop), 2025	Small for gestational age (less 15% (10 p) of registered livebirths)	1st trimester	retrospective cohort	unexposed (general population or NOS)	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.17 [0.01;2.74] C	0/29   9,447/99,522	9,447	29		ref
S18784 R79942	Maya, 2025	Small for gestational age birth weight (<10th percentile for gestational age and sex)	3 months or more before pregnancy or1st trimester excluded	retrospective cohort	unexposed (general population or NOS)	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified Matched	0.70 [0.37;1.31] excluded (exposition period)	13/200   56/600	69	200		ref
					Total	1 studies	0.17 [0.01;2.74]		9,447	29
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 18830