A symposium on the final day of the 84^th Scientific Sessions will feature a panel of experts who will review commonly used diabetes medications that have been associated with fetal complications and current recommendations for their discontinued use during pregnancy, despite significant maternal benefits outside of pregnancy.

Myth Busters on “Category X” Drugs in Pregnancy—Evidence for Stopping Commonly Used Medications during Pregnancy, Preconception, and Lactation will take place on Monday, June 24, from 8:00 a.m. – 9:30 a.m. ET in Room W414 of the Orlando Convention Center. The session will be livestreamed on the virtual meeting platform for registered meeting participants. It also will be available on-demand following the 84^th Scientific Sessions.

Ira J. Goldberg, MD, the Clarissa and Edgar Bronfman Jr. Professor of Endocrinology and Director of the Division of Endocrinology, Diabetes and Metabolism at New York University Langone Health, will discuss the use of lipid-lowering drugs during pregnancy.

Generally speaking, he said that endocrinologists and obstetricians should be aware of the increased risk of pancreatitis in patients with increased triglyceride levels, particularly those with genetic defects, as well as the potential risk for patients with less severe increases in triglyceride and cholesterol who become pregnant while they are taking lipid-lowering medications.

“Pancreatitis risk needs to be considered and a plan needs to be developed in severely hypertriglyceridemia patients,” Dr. Goldberg said. “Patients with high cholesterol who take statin medications should stop taking them when pregnant, although the risks during pregnancy might be minimal.”

Maisa N. Feghali, MD, MSCR, Assistant Professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh and Division of Maternal Fetal Medicine at UPMC Magee-Womens Hospital, will talk about counseling patients who are pregnant or who are planning to be regarding the use of glucagon-like peptide-1 (GLP-1) receptor agonists.

“This is a challenge for clinicians because this is such a novel class of medication that has really taken the world by storm,” Dr. Feghali said. “Beyond diabetes, given its benefits with regard to weight loss and minimal side effects that we’ve seen so far, we’re likely to continue to see increasing use of these agents.”

While there is some data from animal studies suggesting some risk in very high doses of GLP-1 receptor agonists during pregnancy, Dr. Feghali said more research is needed to determine the risk in humans.

“At this point, given the lack of data, there is no straightforward path to using these medications during pregnancy in the same way they are currently used outside of pregnancy, so the recommendation is to try and stop these medications two to three months before getting pregnant,” she said. “Realistically though, we’re going to have quite a few patients who are going to be taking these medications when they find out that they’re pregnant, so there should be an earnest effort to collect data in an opportunistic way in women who had exposure to the medication early on in pregnancy and then follow up and see what their pregnancy outcomes are.”

Also during this symposium, Jason G. Umans, MD, PhD, Georgetown-Howard Universities Center for Clinical and Translational Science, will review the types of medications most likely to cause problems in pregnancy, and Jessica S. Tangren, MD, Massachusetts General Hospital, will discuss the use of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin receptor blockers.