What does Genesis 21:1 mean?
ESV: The LORD visited Sarah as he had said, and the LORD did to Sarah as he had promised.
NIV: Now the LORD was gracious to Sarah as he had said, and the LORD did for Sarah what he had promised.
NASB: Then the Lord took note of Sarah as He had said, and the Lord did for Sarah as He had promised.
CSB: The Lord came to Sarah as he had said, and the Lord did for Sarah what he had promised.
NLT: The Lord kept his word and did for Sarah exactly what he had promised.
KJV: And the LORD visited Sarah as he had said, and the LORD did unto Sarah as he had spoken.
NKJV: And the Lord visited Sarah as He had said, and the Lord did for Sarah as He had spoken.
Verse Commentary:
The Lord keeps His promises, no matter how unlikely they may seem from a human perspective. Not only had God promised to make Abraham a great nation, He had promised specifically that this nation would come through Sarah, a vow made twice within the last year (Genesis 17:16–21; 18:10–15). Now the Lord visits Sarah "as he had said" and the Lord does to her "as he had promised." Somehow, in this visiting, the Lord made Sarah, finally, able to conceive a child with Abraham.

It's interesting that, though most of God's promises about the great nation that would flow from Abraham have been made directly to Abraham, the focus of the promise's fulfillment rests on Sarah. God maintains a relationship with her and His promise is made to and through her.

The repetition and phrasing in this verse is meant to slow us down and cause us to notice that God is faithful. He does as He says.
Verse Context:
Genesis 20:1–7 describes the moment Abraham and Sarah have been waiting on for many, many years. Ever since leaving their home to begin to wander in the land of Canaan, this is a promise they have wished to see fulfilled. God had promised to make Abraham a great nation, by giving him and Sarah a naturally-born son. Finally, their first child together is born. Isaac's name means ''laughter,'' and Sarah expresses her joy at his birth. God has done the unbelievable. He has made laughter for her.
Chapter Summary:
The Lord did as He had promised. Sarah, now 90 years old, gives birth to Isaac, the long-awaited child. Her joy sours, though, over a fear that Isaac might have to share an inheritance with Ishmael. In obedience to the Lord, who promises to safeguard Ishmael, Abraham sends him and his mother, Hagar, into the wilderness. God rescues them and renews His promise to make Ishmael a great nation in his own right. Meanwhile, Abimelech, king of Gerar, approaches Abraham to make a permanent treaty between them and their descendants. The agreement includes Abraham's possession of a well, at a place which will become known as Beersheba.
Chapter Context:
In the prior chapter, Abraham managed to get Sarah back from Abimelech, following his own deception and God's intervention. Here, Abraham and Sarah finally conceive a natural child. Isaac, the long-awaited child of the promise, is born. In obedience to God, Abraham sends Hagar and Ishmael away. Abimelech approaches Abraham to make a treaty, giving Abraham a permanent home in a place that becomes known as Beersheba. In the following chapter, God will test Abraham's faith and obedience, in one of Scripture's ultimate examples of trust.
Book Summary:
The book of Genesis establishes fundamental truths about God. Among these are His role as the Creator, His holiness, His hatred of sin, His love for mankind, and His willingness to provide for our redemption. We learn not only where mankind has come from, but why the world is in its present form. The book also presents the establishment of Israel, God's chosen people. Many of the principles given in other parts of Scripture depend on the basic ideas presented here in the book of Genesis. Within the framework of the Bible, Genesis explains the bare-bones history of the universe leading up to the captivity of Israel in Egypt, setting the stage for the book of Exodus.
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