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

Large for gestational age (weight)

id	Study   Auto Kolding - Semaglutide (Controls exposed to insulin), 2025Kolding - Semaglutide (Controls unexposed, general pop), 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.
S18794 R79986	Kolding - Semaglutide (Controls exposed to insulin), 2025	Large for gestational age (plus 22% (3 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	0.35 [0.12;0.92] excluded (control group)	6/29   218/514	224	29		ref
S18796 R79993	Kolding - Semaglutide (Controls unexposed, general pop), 2025	Large for gestational age (plus 22% (3 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	5.94 [1.98;15.02]	6/29   4,184/99,522	4,190	29		ref
S18782 R79922	Maya, 2025	Large for gestational age birth weight (>90th percentile for gestational age and sex)	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	1.03 [0.79;1.35] excluded (exposition period)	71/442   196/1,326	267	442		ref
S18788 R79970	Pondugula, 2025	Large-for-gestational-age birth weight (birth weight at or above the 90th percentile for a given gestational age)	early pregnancy	retrospective cohort	unexposed, sick	Adjustment: No GLP1-RA indication: Overweight/Obesity	1.07 [0.50;2.30] C	11/90   23/200	34	90		ref
S18768 R79861	Dao (Controls exposed to metformin/insulin), 2024	Large for gestational age (birth weight exceeding the 90th percentile based on WHO infant sex-specific growth charts)	1st trimester	prospective cohort	exposed to other treatment, sick excluded	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	0.70 [0.37;1.33] C excluded (control group)	20/113   29/124	49	113		ref
S18806 R80017	Dao (Controls unexposed, sick), 2024	Large for gestational age (birth weight exceeding the 90th percentile based on WHO infant sex-specific growth charts)	1st trimester	prospective cohort	unexposed, sick	Adjustment: No GLP1-RA indication: Mixed (Diabetes and/or Overweight) or Unspecified	3.38 [1.37;8.34] C	20/113   7/117	27	113		ref
					Total	3 studies	2.67 [0.96;7.40]		4,251	232
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