The use of weight loss medication in women of reproductive age – a mixed methods exploration of patient and health care professionals needs and experiences.

Research Question

What are the needs, experiences, knowledge, and acceptability around the use of glucagon-like peptide-1 reception
agonists (GLP-1RAs) by women aged 18-45 years and the health professionals caring for them?
Background

Obesity in pregnancy (a Body Mass Index (BMI) ≥30 kg/m2) is associated with many adverse outcomes for mothers and infants, including gestational diabetes, congenital-abnormalities, pre-eclampsia, preterm birth, and stillbirth. There is an increasing emphasis on optimisation of BMI before pregnancy, but current interventions have not been successful. Recently licenced GLP-1RAs weight loss medications could help women reduce weight pre-pregnancy to improve pregnancy outcomes. The daily/weekly injections are in high demand and available on prescription from some NHS specialist weight management clinics. Otherwise, they may be purchased online via private prescription, or more concerningly from unregulated websites without healthcare professional (HCP) supervision. GLP-1RAs offer a novel approach to reducing maternal obesity with direct patient benefit. However, they are potentially teratogenic and unsafe to be used during pregnancy, so should only be used with contraception. Recent
research by our group and PPI discussion found understanding and needs of women and HCPs around GLP-1RA use in relation to women’s health is unknown. Research to explore ‘real life’ experience is important to learn from participants and determine the correct questions and outcome measures before planning a feasibility trial comparing weight loss methods before pregnancy.

Aims and Objectives

To understand and determine the needs, experiences, knowledge, and acceptability around the use of GLP-1RAs by women aged 18-45 and the HCPs caring for them, to inform a future feasibility trial of GLP-1RA use before pregnancy.

Design and Methods

This is an exploratory study using qualitative methods and a cross-sectional survey in two parts designed with our patient group. Part 1 will inform Part 2.

Part A
1. Semi-structured interviews (n=30) with women recruited from three geographically disparate NHS weight
management services who have used, considered using or are using GLP-1RAs.
2. Semi-structured interviews with women (n=10) who have obtained GLP-1RAs online. Recruitment from social media platforms, using paid advertisements

Part B
Cross sectional national HCP survey (n=160) and subsequent semi-structured interviews (n=20) exploring knowledge, practices, and facilitators/barriers to providing preconception/contraceptive advice in relation to GLP- 1RAs in women aged 18-45 years. Recruitment via social media and professional organisation networks.

Analysis

The recorded interviews and free text survey comments will be downloaded into NVivo (QSR-International 2020) and analysed thematically in six steps as described by Braun and Clarke (2021). The HCP survey will be analysed using descriptive statistic.

Anticipated Impact/Dissemination:

This research will generate novel data on the use of GLP1-RAs and women’s health, against a rapidly changing clinical landscape. This will inform the feasibility of a definitive trial of use of GLP-1RAs in preconception reduction of
obesity. Dissemination will be planned creatively with PPI and stakeholder groups and is expected to include digital media disseminated across obesity and fertility patient websites. Traditional dissemination will also take place via academic journals, professional organisations, and conferences.

Aims:
1. To understand the needs, experiences, knowledge, and acceptability of women aged 18-45 years around
the use of GLP-1RAs.
2. To understand the knowledge, practices, needs and experiences of HCPs who work in settings where GLP1-
RAs are prescribed to women aged 18-45 years.
Objectives:
1. To undertake semi-structured interviews with women aged 18-45 years recruited from NHS tier 3 weight
management who have used, considered using or are using GLP1-RAs.
2. To undertake semi -structured interviews with women aged 18-45 years who have obtained GLP1-RAs
online
3. To conduct a national survey of HCPs who care for women aged 18-45 years about their practices in relation
to use of GLP-1RAs.
4. Undertake semi-structured interviews in a subset of HCPs to understand their experiences and any
facilitators/barriers to providing preconception and contraceptive advice in relation to GLP-1RAs to women
aged 18-45 years.