Heather Hopper

Introduction: Pregnancy concurrent with incretin‐based medications is contraindicated due to unknown risk of teratogenicity, as is breastfeeding. The aim of this systematic scoping review was to investigate potential risks and benefits of incretin‐based medications in relation to preconception, pregnancy, and postnatal health, and to propose expert guidelines for clinical practice. Methods: An international expert multidisciplinary group was formed. Research questions relevant to women's reproductive health and incretin‐based medications were refined collaboratively, utilizing a lifecourse approach. A systematic search was undertaken on July 23, 2025, across several databases and grey literature sources. Primary data from human studies were prioritized above animal studies. Titles, abstracts, and full text articles were screened independently by two authors. Data were extracted by two people independently using a pre‐defined proforma and synthesized narratively. Consensus recommendations were made. Results: Thirty‐four articles were included in the evidence synthesis: 11 randomized trials, nine observational studies, two pharmacovigilance reviews, nine case reports/series, two animal studies, and one ex vivo study. No qualitative studies were identified. Evidence was found for 18/32 (56.3%) research questions. Most studies related to preconception or pregnancy usage; two addressed contraception, and one was about lactation. The sample size of exposed pregnancies ranged from 1 to 4267. Three studies reported exposure throughout pregnancy. Three studies investigated postpartum usage. One (animal) study had offspring data beyond birth. No studies reported an increase in congenital anomalies. Conclusion: Clinical practice and research recommendations were made based on current available evidence and evidence gaps, encompassing contraception, preconception, nutritional, pregnancy monitoring, lactation, and longer‐term outcomes.

Preconception care for people with chronic health conditions is recommended in view of the implications for them and their offspring during pregnancy and beyond. This realist review of published and grey literature explored factors that explain why people seek or receive appropriate preconception counseling and why they engage in recommended health behavior change prior to pregnancy. Fifty-two studies contributed to phase one synthesis, and 38 studies provided explanations in phase two. Ten program theories were developed, explored, and refined through iterative discussion and coding. Causal explanations of the ways in which components of preconception care contribute to effective access to care and prepregnancy behavior change were identified. Beneficial components included continuity of carer (promoting trust), a partnership approach (empowering people who feel valued), promoting an integrated approach across primary and secondary care, offering psychological counseling (recognizing the link between physical and psychosocial aspects of living with health conditions), considering sexual and reproductive health as part of routine care, and normalizing conversations about preconception care (to reduce the barrier created by social and cultural norms). These key aspects have been highlighted for consideration when planning, implementing, and improving preconception care services for people with health conditions.

OBJECTIVE— We aimed to examine sex differences in insulin and insulin propeptide concentrations at birth using validated cord blood collection. RESEARCH DESIGN AND METHODS— We tested the impact on insulin and insulin propeptides of taking 13 cord blood samples in heparin and EDTA and then centrifuging and separating plasma after 1, 2, 24, or 48 h at room temperature (heparin) or 4°C (EDTA). Cord plasma insulin and insulin propeptides concentrations were measured in 440 babies and correlated with offspring anthropometry measured at birth. RESULTS— Cord insulin concentrations significantly decreased (74% those at baseline by 24 h; P = 0.01) in the samples taken in heparin and stored at room temperature, but those taken on EDTA and refrigerated remained stable for up to 48 h. Insulin propeptides were stable in both. Cord plasma insulin and insulin propeptides measured in EDTA were related to all measures of birth size and maternal glycemia and BMI (r > 0.11; P < 0.03 for all) and were higher in those delivered via caesarean section. Girls were lighter (3,497 vs. 3,608 g; P = 0.01) but had higher cord insulin (46.7 vs. 41.2 pmol/l; P = 0.031), total proinsulin (34.1 vs. 25.8 pmol/l; P < 0.001), and intact proinsulin (9.5 vs. 8.3 pmol/l; P = 0.004) concentrations than boys; this was further confirmed when cord insulin concentrations of boys and girls were compared after pair matching for birth weight (insulin 49.7 vs. 42.1 pmol/l; P = 0.004). CONCLUSIONS— When using appropriate sample collection methods, female newborns have higher insulin concentrations than male newborns, despite being smaller, suggesting intrinsic insulin resistance in girls.