Highlight
– First-trimester use of second-line glucose-lowering agents, including GLP-1 receptor agonists and sulfonylureas, does not significantly increase the overall risk of major congenital malformations compared with insulin alone.
– Slightly elevated risk of cardiac malformations is suggested with first-trimester exposure to GLP-1 receptor agonists and sulfonylureas.
– This large population-based study advances the safety profile understanding of newer glucose-lowering therapies in pregnancy complicated by type 2 diabetes.
– Findings emphasize cautious use of newer agents during early pregnancy and support ongoing pharmacovigilance.
