Case Series: Exposure to Glucagon-like Peptide-1 Receptor Agonist in the First Trimester of Pregnancy in Two Siblings

Background: The safety of glucagon-like peptide-1 receptor agonists in pregnancy is under investigation. In this report, we want to share the results of a patient with polycystic ovary syndrome who applied to our outpatient clinic for diabetes and had two unplanned pregnancies following the initiation of exenatide for obesity treatment. Case Presentation: A 40-year-old woman with diabetes was admitted to the endocrinology outpatient clinic. On physical examination, the body mass index was over 35 kg/m ², therefore, exenatide treatment was started. Four weeks later, she came to suspicion of pregnancy, and obstetric ultrasound revealed a fetus at 17 weeks of gestation. Exenatide was interrupted. At 37 weeks of gestation, she gave birth to a female baby with atrial septal defect. The baby was followed with echocardiography annually until spontaneous closure of ASD when she was three years old. Two years later, the patient consulted us again for weight gain. Exenatide was prescribed again. After 5 months, an abdominal ultrasound revealed a fatty liver and detected a pregnancy compatible with 13 weeks of gestation. Two siblings are healthy now, 7 and 5 years old, respectively. Conclusion: This report contributes to our knowledge of fetal exposure to exenatide. Large-scale randomized studies are needed for its safe use in pregnancy.