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The included studies on exendin-4 exposure were all performed in mouse models ( In rat, mouse and rabbit models without systemic inflammation, the other GLP1-receptor agonists (except exendin-4), dose dependently caused reduced fetal weight and/or growth, retardation of ossification, irregular ossification, and/or skeletal variants such as wavy ribs ( Table 1 )

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Additionally, the modest sample size limits generalizability and statistical power, and replication in larger cohorts is required