Timing of GLP-1 Receptor Agonist Fills Relative to Conception Among Commercially Insured Women

Abstract

GLP-1 receptor agonists are not recommended in pregnancy, and semaglutide labeling advises discontinuation at least two months before conception, yet the timing of cessation relative to conception has not been described. Using 2017-2025 MarketScan commercial claims, we study women ages 15-49 with an inpatient live birth in 2019-2025 and date conception from gestational-age diagnosis codes. Preconception GLP-1 utilization grew from under 0.05% in 2019 to over 1% in 2025. Most of the decline in utilization followed conception rather than preceding it, placing cessation at pregnancy recognition: among deliveries with any preconception-year fill, 35.9% last filled within 30 days of conception. Contraception and pregnancy-intention counseling should occur at GLP-1 initiation and dose escalation, not only at pregnancy identification.