New research eases fear of GLP-1 during early pregnancy
GLP-1 drug use among women of reproductive age is increasing across the United States, and while experts recommend stopping the drugs before getting pregnant, sometimes unintentional early exposure happens. Now, a new study is offering some reassurance for women in that situation.
The study published in Annals of Internal Medicine looked at 3,600 women ages 16 to 55 and found similar risk of pregnancy loss, abnormal fetal growth and major congenital malformations when comparing pregnancies where GLP-1 medications were continued into the first trimester with those in which they were stopped. The data showed no apparent definitive increase for continued medication use. However, the study authors recommended further research to better understand the safety of GLP-1 use during pregnancy.
Dr. Jay Idler, a maternal fetal medicine physician with Allegheny Health Network (AHN), says he is seeing more women of reproductive age in his practice using GLP-1 medications.
“As these treatments become more common for weight management and diabetes, it is not unusual for someone to conceive while taking them, often before they realize they are pregnant,” says Idler. “With the growing number of patients on GLP-1 receptor agonists, early pregnancy exposure is something we are encountering more often in routine care.”
Women considering pregnancy often ask whether it’s safe to take the drugs before conceiving and when to stop them, but sometimes women end up still taking the drugs before realizing they are pregnant. “Animal studies have raised concerns about lower fetal weight and possible birth defects, but the real world data we have from pregnancy has not shown those same patterns,” Idler says. “Observational studies so far have found similar rates of pregnancy loss and similar rates of babies who are smaller or larger at birth when compared with people who were not exposed. Our understanding is still limited because we do not have randomized trials in pregnancy.”
It is also important to stress that stopping these medications can have its own consequences. Discontinuation has been linked with rapid weight gain in pregnancy, a higher chance of preterm delivery, and a greater risk of conditions like gestational diabetes and high blood pressure.
“At this point, national societies and clinical guidelines advise stopping these medications either two months before trying to conceive or as soon as pregnancy is confirmed,” Idler said. “So the discussion is really about balancing what we know, what we do not yet know, and the individual risks of stopping treatment. Because we still have limited information, the safest approach right now is to stop GLP-1 medications at least two months before trying to conceive. During that time, we advise using reliable birth control so there is no unplanned exposure.”
For people who have diabetes, it is also important to make sure their blood sugar has been well controlled in the months leading up to pregnancy. One way doctors check this is with a hemoglobin A1C test, which gives an average of blood sugar levels over the past few months.
“I also encourage patients to meet with a dietician or nutritionist,” Idler says. “These medications can affect appetite, and once they are stopped, some people experience rapid weight gain. Having support around nutrition can help with a healthy transition into pregnancy. Once these steps are in place, it is reasonable to start trying to conceive.”
Many women worry that GLP-1 medications might harm their fertility or future pregnancies, but the evidence so far does not support that concern. In fact, studies show the opposite. Research in patients with obesity has found that GLP-1 medications can improve fertility, increase spontaneous pregnancy rates, and help regulate menstrual cycles. These benefits appear to come not only from weight loss but also from direct effects on hormones and ovarian function. Because fertility often improves quickly, there is also a higher chance of an unexpected pregnancy, which is why reliable birth control is important while taking these medications.
“Professional societies do not recommend avoiding these medications throughout the reproductive years. Instead, they advise stopping them before pregnancy, usually about two months before trying to conceive, because we do not yet have randomized trial data in pregnancy,” says Idler. “The medications clear from the body within weeks, and there is no evidence of lasting effects on fertility or future pregnancy outcomes.
“For many patients, especially those with obesity, using GLP-1 medications before pregnancy can actually improve metabolic health and lower the risk of complications once they do conceive, so long as they maintain good nutritional intake and follow appropriate weight gain recommendations throughout the pregnancy.”