(327) Use of Weight-Loss Medications Among Pregnant People in the Optum Research Database

Background: Wegovy (semaglutide) was approved in June 2021 for chronic weight management in adults with obesity or overweight with at least one weight-related condition; other formulations of semaglutide might also be prescribed off-label for weight-loss. Prenatal exposure to semaglutide and other diabetes medications has increased in recent years among individuals with pregestational type 2 diabetes. However, utilization of semaglutide among pregnant people is unknown.

Objectives: To describe utilization of weight-loss medications including semaglutide among pregnant people.

Methods: This study was conducted using health insurance claims data from the Optum Dynamic Assessment of Pregnancies and Infants (DAPI) database. The date of last menstrual period (LMP) was estimated using validated algorithms via ICD-10 Z3A codes or pregnancy outcomes codes. Pregnancies with an LMP from January 1, 2020 through October 31, 2023 among women aged 12-55 years were eligible. The study period was chosen to capture time before and after approval of semaglutide for weight management. Pharmacy dispensings of weight-loss medications (based on NDC codes) were identified in the 6 months before pregnancy through the end of pregnancy. Diagnoses of overweight/obesity and diabetes were identified during the 6 months before pregnancy (baseline).

Results: We identified 380,900 eligible pregnancies, among which 38,865 (10.2%) were classified as overweight or obese and 37,568 (9.9%) were classified as overweight or obese without evidence of diabetes. Semaglutide dispensings during baseline or pregnancy were identified in 887 women, while there were 0 with orlistat, 22 with bupropion-naltrexone, 213 with liraglutide, and 14 with phentermine-topiramate. About half of semaglutide recipients were aged ≥35 years at LMP. Semaglutide dispensings decreased from baseline (n=738) through the second trimester (n=95) but increased in the third trimester (n=481). Among semaglutide recipients, 523 (59.0%) were overweight or obese, 367 (41.4%) had diabetes, and 353 (39.8%) were overweight or obese without diabetes; 30 (3.4%) had ICD-10 codes for BMI of 25-29, 212 (23.9%) for BMI of 30-39, and 162 (18.3%) for BMI ≥40.

Conclusions: Though semaglutide was the most frequently dispensed weight-loss medication during pregnancy, utilization of weight-loss medications was infrequent. Sizeable numbers of semaglutide-exposed pregnancies occurred and many of them discontinued use during pregnancy.