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

Preterm (< 37 weeks)

id	Study   Auto Chou, 2025Kolding - Semaglutide (Controls exposed to insulin), 2025Kolding - Semaglutide (Controls unexposed, general pop), 2025Lewin, 2025Maya, 2025Pondugula, 2025Dao (Controls exposed to metformin/insulin), 2024Dao (Controls unexposed, sick), 2024	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.
S18797 R80003	Chou, 2025	Preterm birth (<37 weeks)	1st trimester	population based cohort retrospective	exposed to other treatment, sick	Adjustment: No GLP1-RA indication: Type 2 diabetes (T2D)	1.35 [0.95;1.91]	26/66   74/253	100	66		ref
S18794 R79984	Kolding - Semaglutide (Controls exposed to insulin), 2025	Preterm birth (22-37 SA)	1st trimester	retrospective cohort	exposed to other treatment, sick excluded	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.83 [0.27;2.15] excluded (control group)	6/30   122/527	128	30		ref
S18796 R79991	Kolding - Semaglutide (Controls unexposed, general pop), 2025	Preterm birth (22-37 SA)	1st trimester	retrospective cohort	unexposed (general population or NOS)	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	4.95 [1.65;12.43]	6/30   4,846/100,788	4,852	30		ref
S18829 R80166	Lewin, 2025	Preterm delivery (22 to <37 weeks)	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: No GLP1-RA indication: Type 2 diabetes (T2D)	1.14 [1.11;1.17] C	9,442/40,929   27,358/131,279	36,800	40,929		ref
S18782 R79924	Maya, 2025	Preterm delivery (28-36 weeks’ gestation)	3 months or more before pregnancy or1st trimester excluded	retrospective cohort	unexposed (general population or NOS)	Adjustment: Yes GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified Matched	1.21 [0.96;1.53] excluded (exposition period)	99/566   223/1,698	322	566		ref
S18788 R79972	Pondugula, 2025	Preterm birth (birth between 20 0/7 and 36 6/7 weeks of gestation)	early pregnancy	retrospective cohort	unexposed, sick	Adjustment: No GLP1-RA indication: Overweight/Obesity	1.66 [0.80;3.45] C	14/90   20/200	34	90		ref
S18768 R79860	Dao (Controls exposed to metformin/insulin), 2024	Preterm (<37 weeks of gestation after last menstrual period)	1st trimester	prospective cohort	exposed to other treatment, sick excluded	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.49 [0.21;1.13] C excluded (control group)	9/113   19/126	28	113		ref
S18806 R80016	Dao (Controls unexposed, sick), 2024	Preterm (<37 weeks of gestation after last menstrual period)	1st trimester	prospective cohort	unexposed, sick	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.51 [0.22;1.19] C	9/113   17/117	26	113		ref
					Total	5 studies	1.32 [0.91;1.91]		41,812	41,228
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 18768, 18794

Umbrella review (other published meta-analyses)