GLP-1 Drugs and Pregnancy: A Trends Update

GLP-1 receptor agonists are among the most prescribed medicines for type-2 diabetes and obesity in reproductive-age women. That creates a question that did not exist a decade ago: what happens when a woman on semaglutide or another GLP-1 drug decides to try for a baby? A letter published in Diabetes, Obesity and Metabolism in September 2026 by Boghossian et al. examined real-world GLP-1 therapy use patterns in the period before and after pregnancy^[1], and the findings raise straightforward but important points about the gap between clinical guidance and practice.

What current guidance says

Current clinical guidance is clear on one point: GLP-1 receptor agonists should be stopped before conception, not after a pregnancy test comes back positive. The joint Endocrine Society and European Society of Endocrinology clinical practice guideline (Wyckoff et al., 2025) recommends "discontinuation of glucagon-like peptide-1 receptor agonist before conception rather than discontinuation between the start of pregnancy and the end of the first trimester"^[2]. The guideline panel noted that the evidence base supporting this recommendation is of very low to low certainty, which underlines how thin the human safety data actually are.

The reason for the pre-conception recommendation is precautionary: animal reproduction studies with semaglutide and liraglutide found fetal harm at doses producing clinical exposure levels, and no adequate controlled human studies exist in pregnant women. The product labels for both Ozempic and Wegovy advise women who plan to become pregnant to stop the medicine before conception. The exact washout period recommended on the label varies by product and indication; the prescribing clinician is the right person to advise on timing for a given individual.

What a real-world trends study adds

The Boghossian et al. correspondence looked at how GLP-1 use patterns actually unfold around pregnancy in a real-world dataset^[1]. The publication is a letter rather than a full trial report, which means the methods and sample sizes are summarised rather than presented in full. That is a limitation worth naming clearly. What the study captures is the real-world picture: who stops before conception, when they stop, and whether they restart after delivery.

The study comes from researchers at the University of South Carolina, Prisma Health, Inova Fairfax Hospital, The Ohio State University, and Virginia Health Sciences at Old Dominion University. The authors flagged real-world data on GLP-1 discontinuation timing and postpartum resumption as the core contribution. The trends framing is important because the number of reproductive-age women prescribed GLP-1 drugs has increased sharply since 2021, so even a modest gap between guidance-recommended practice and actual practice translates into a meaningful number of pregnancies with periconceptional exposure.

Periconceptional exposure: what the safety evidence shows

A 2025 systematic review in Diabetes, Obesity and Metabolism (Ozbek et al.) examined 36 human studies of GLP-1 and dual GLP-1/GIP receptor agonist exposure around conception. The review found that periconceptional or early-pregnancy exposure to GLP-1 therapies was "not consistently associated with increased risk of major congenital malformations" across large observational cohorts^[3]. A separate systematic scoping review in Obesity Reviews (Maslin et al.) covered the same territory and found no studies reporting an increase in congenital anomalies, though the same review also described pregnancy concurrent with incretin-based medications as contraindicated due to unknown teratogenicity risk^[4].

The apparent tension between these two findings is worth unpacking. The absence of a detected signal in observational data does not mean a risk has been ruled out. It means the available cohort studies, most of them covering short windows of early exposure before discontinuation, have not found one. Long-term fetal outcomes from sustained in-utero exposure have not been studied in humans, and the animal data remain concerning at clinical exposure levels. This is why current guidance defaults to the precautionary position: stop before trying to conceive.

The postpartum picture

The postpartum period is where the trends data raise a different set of questions. Women who stop a GLP-1 drug before conception may carry elevated cardiometabolic risk through pregnancy and into the postpartum period without the metabolic support these medicines provide. A 2026 review in the American Journal of Preventive Cardiology (Vardhan et al.) noted that GLP-1 agonists represent a promising preventive strategy for cardiometabolic risk reduction in reproductive-age women, but that data specific to this population remain limited^[6].

Postpartum resumption of GLP-1 therapy is a clinical decision that depends on breastfeeding status, metabolic status, and available evidence on lactation exposure. Current guidance generally advises against use during breastfeeding given the lack of human lactation data. For women who are not breastfeeding, the timing of resumption is an individualised clinical decision based on risk and benefit for that patient.

Why this is a growing clinical concern

The number of reproductive-age women prescribed GLP-1 drugs is large and growing. A 2025 review in Paediatric Drugs (Porterfield et al.) noted that GLP-1 receptor agonist use is increasing in preconception and postpartum periods, and called for high-quality prospective research in this population^[5]. That call is consistent with what the Boghossian et al. trends letter documents: a widening gap between guidance and the real-world patterns of use.

The practical implication is that clinicians prescribing GLP-1 drugs to women of reproductive age need to discuss pregnancy planning at every relevant visit, and women considering pregnancy who are currently on these medicines need to have the pre-conception discontinuation conversation well before they start trying. The guidance that this discussion should happen before conception, not after a positive test, exists precisely because the first trimester is the window of highest organogenesis risk.

What we do not know

The evidence base here has well-defined gaps. No adequately powered prospective study has followed pregnancies through full term after sustained GLP-1 exposure. Long-term neurodevelopmental and metabolic outcomes in children born to women who used these medicines periconceptionally are unstudied. Lactation safety data are essentially absent for humans. The Endocrine Society guideline panel explicitly rated their recommendation evidence as very low to low certainty, which is the correct framing given the current data. The trends letter by Boghossian et al. is a contribution to the descriptive literature, not to the safety literature, which still needs prospective cohort work.

If you are currently taking a GLP-1 receptor agonist and thinking about pregnancy, the most important step is to raise it with the clinician who manages your prescription. The timing of discontinuation, what (if anything) to use in the interim for your metabolic condition, and when to consider resuming postpartum are all decisions that depend on your specific health profile and cannot be answered generically.