DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS 
This retrospective cohort study examining 1.6 million Australian women reveals concerning fertility implications as GLP-1 receptor agonist prescribing increased 11-fold among reproductive-age women, with 91% of new users lacking diabetes in 2022. The research demonstrates significant unintended pregnancy risk within six months of initiation, particularly given inadequate contraceptive coverage at treatment start.
⚕️ Key Clinical Considerations ⚕️
- Pregnancy incidence: 2% of women conceived within six months of GLP-1 RA initiation, with highest rates in 18-29 year-olds with diabetes (4%) and 30-34 year-olds without diabetes (6%).
- PCOS amplification effect: Women with polycystic ovary syndrome showed doubled conception rates (adjusted RR 2.04), suggesting weight-loss-mediated fertility restoration.
- Contraceptive inadequacy: Only 21% used contraception at initiation, with long-acting reversible contraception coverage below national averages across all patient groups.
- Off-label prevalence: Among 2022 initiators, 91% lacked diabetes diagnosis, indicating predominant weight management use in reproductive-age population.
- Fertility restoration mechanism: Modest weight reductions can improve ovulatory function, creating unintended pregnancy risk when effective contraception absent.
🎯 Clinical Practice Impact 🎯
- Patient Communication: Mandatory fertility counseling required before GLP-1 RA initiation, including discussion of weight-loss-mediated ovulation restoration and teratogenic risks during organogenesis.
- Practice Integration: Implement standardized contraceptive assessment protocols with long-acting reversible contraception discussion for all reproductive-age women starting GLP-1 therapy.
- Risk Management: Establish pregnancy testing protocols and contraceptive counseling documentation requirements, particularly for PCOS patients who demonstrate highest conception risk.
- Action Items: Develop patient education materials addressing fertility changes, ensure adequate contraceptive coverage before treatment initiation, and establish follow-up protocols for pregnancy surveillance.
More on Contraception/Birth Control
