Periconceptional and early-pregnancy exposure to SGLT2 inhibitors and congenital malformations: a systematic review and meta-analysis

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are increasingly prescribed to women of reproductive age for type 2 diabetes and cardiorenal protection, and are commonly continued through the periconceptional period until pregnancy is recognized. Human safety data on inadvertent first-trimester exposure remain scarce, creating substantial clinical uncertainty.

We systematically searched PubMed/MEDLINE, Embase, and CENTRAL from inception to 15 May 2026 for observational cohort studies comparing early-pregnancy or preconception exposure to SGLT2 inhibitors with active antidiabetic comparators among women with type 2 diabetes. Adjusted risk ratios (RRs) were pooled using random-effects meta-analysis.