Maternal cardiometabolic health and the role of GLP-1 receptor agonists from preconception to postpartum: A review of evidence and opportunities

Abstract

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of maternal mortality. Adverse pregnancy outcomes (APOs), including preeclampsia and gestational diabetes, confer significant long-term cardiometabolic risk, yet prevention strategies during the preconception and postpartum periods are limited. Glucagon-like-peptide 1 receptor agonists and/or combined therapies (GLP-1 agonists) have demonstrated substantial benefits in weight reduction, glycemic and lipid control, and cardiovascular risk reduction in nonpregnant populations, but their impact on cardiometabolic health in women with increased risk of CVD during peripartum phases has not been defined. CONTENT: GLP-1 agonists are not approved for use during pregnancy or lactation; however, emerging evidence suggest a potential role in preconception weight optimization and postpartum metabolic recovery. This review highlights the mechanisms of GLP-1 agonists, evaluates available safety and efficacy data relevant to reproductive-age populations, and examines the potential application GLP-1 agonists during the preconception and postpartum periods, while also highlighting current clinical uncertainties. SUMMARY: GLP-1 agonists represent a promising preventive strategy for cardiometabolic risk reduction in women with increased risk of CVD. However, data specific to reproductive-age populations remain limited, leaving critical gaps regarding safety, efficacy, optimal timing of use, and implementation. Recognizing the preconception and postpartum periods as pivotal windows for CVD prevention underscores the need for focused research to guide evidence-based integration of effective interventions into preventative cardiovascular care for women.