In this cohort study by the InPreSS consortium including more than 50 000 pregnancies in women with pregestational T2D from 6 countries, we observed no elevated risk of MCMs after periconceptional exposure to GLP-1 receptor agonists or any of the second-line noninsulin ADM classes evaluated compared with insulin, another second-line ADM and the traditional treatment for T2D in pregnancy. This evidence concerns the gene GLP1R and type 2 diabetes mellitus.