Glucagon-like peptide-1 (GLP-1) receptor agonists

Early intrauterine deaths (< 22 weeks) / Spontaneous abortions

R analysis
id Study   Lib. in paper Exposition period    Study type 
 Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18829
R80165		 Lewin, 2025 Pregnancy loss/Termination <14 week during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No GLP1-RA indication: Type 2 diabetes (T2D) 1.34 [1.29;1.39] C 4,000/40,929   9,812/131,279 13,812 40,929
ref
S18768
R79858		 Dao (Controls exposed to metformin/insulin), 2024 Spontaneous abortions (<22 weeks) 1st trimester prospective cohort exposed to other treatment, sick excluded Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified 1.31 [0.73;2.36] C
excluded (control group) 		31/168   23/156 54 168
ref
S18806
R80014		 Dao (Controls unexposed, sick), 2024 Spontaneous abortions (<22 weeks) 1st trimester prospective cohort unexposed, sick Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified 1.05 [0.60;1.83] C 31/168   29/163 60 168
ref
Total 2 studies 1.34 [1.29;1.39] 13,872 41,097
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

StudyTE95% CIn casesn exposedweightROBABCDEF Lewin, 2025Lewin, 2025 1.34[1.29; 1.39]13,81240,929100%ROB confusion: criticalROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Dao (Controls unexposed, sick), 2024Dao, 2024 1 1.05[0.60; 1.83]601680%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: unclearROB mesure: criticalROB reporting: moderate Total (2 studies) I2 = 0% 1.34[1.29; 1.39]13,87241,0970.55.01.0ROB: A: confounding, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.34[1.29; 1.39]13,87241,0970%NALewin, 2025 Dao (Controls unexposed, sick), 2024 2 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 1.34[1.29; 1.39]13,87241,0970%NALewin, 2025 Dao (Controls unexposed, sick), 2024 2 Tags Adjustment   - No  - No 1.34[1.29; 1.39]13,87241,0970%NALewin, 2025 Dao (Controls unexposed, sick), 2024 2 GLP1-RA indication   - Mixed (Diabetes and/or Overweight) ...  - Mixed (Diabetes and/or Overweight) or Unspecified 1.05[0.60; 1.83]60168 -NADao (Controls unexposed, sick), 2024 1   - Type 2 diabetes (T2D)  - Type 2 diabetes (T2D) 1.34[1.29; 1.39]13,81240,929 -NALewin, 2025 1 All studiesAll studies 1.34[1.29; 1.39]13,87241,0970%NALewin, 2025 Dao (Controls unexposed, sick), 2024 20.55.01.0

Publication bias and p-hacking diagnosis

funnel plot

Funnel plot not drawn. Less than 3 points.

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot

Funnel plot not drawn. Less than 3 points.

Sub-groups analysis using all included studies

excluded 18768

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed, sick controlsunexposed, sick controls 1.34[1.29; 1.39]13,87241,0970%NALewin, 2025 Dao (Controls unexposed, sick), 2024 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.31[0.73; 2.36]54168 -NADao (Controls exposed to metformin/insulin), 2024 10.510.01.0

Umbrella review (other published meta-analyses)

Published MAControlPeriodTE95% CIn exposedkI2 Armstrong (Miscarriages)Armstrong (Miscarriages) 1.21[0.83; 1.77]0%-Wwhatever (meta-analysis)T11st trimesterstudies TTT-9 Armstrong (Miscarriages)Armstrong (Miscarriages) 1.16[0.82; 1.65]0%-Wwhatever (meta-analysis)Before-Any3 months (or more) before pregnancy or during pregnancystudies TTT-9 metaPregmetaPreg 1.34[1.29; 1.39]0%41,097----Lewin, 2025 Dao (Controls unexposed, sick), 2024 20.510.01.0