GLP-1s and Pregnancy: What Your OBGYN Wants You To Know

Key Takeaways

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GLP-1s can increase pregnancy risk: Certain patient populations (especially those with PCOS) may find it easier to get pregnant while they are using it.

Planning to get pregnant? Stop GLP-1s at least 2 months before trying to conceive — these medications stay in your system longer than you think.

‍If you're pregnant and using a GLP-1: Stop taking it immediately and discuss it with your OBGYN.

If you’re using birth control: GLP-1s can affect how your body absorbs oral contraceptives, so make sure to use backup birth control with each dosage change. Read more about it here.

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The Pattern We Started Noticing

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I remember joking with my partner in the early years of prescribing GLP-1s: "Have you noticed a lot of women are getting pregnant on this?"

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It wasn't just a coincidence. We kept seeing the same pattern with our PCOS patients: women who'd been skipping periods or dealing with irregular cycles for years. They'd start semaglutide or tirzepatide, lose weight, and then one of two things would happen: their periods either didn't come back (because they were already pregnant), OR they had regular periods for a while... and then got pregnant.

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As OBGYNs, we want to dive deeper into how GLP-1s affect fertile women — and the findings so far are quite interesting.

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Why GLP-1s Might Help With Fertility

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GLP-1s do more than just help with weight loss: they act as anti-inflammatory medications by suppressing inflammatory signals in the body. This effect happens independently of the weight loss itself.

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Yes, losing excess fat reduces inflammation (because dysfunctional fat tissue creates inflammation). But the GLP-1 mechanism adds another layer of anti-inflammatory benefit that may be especially helpful for women with PCOS, where inflammation plays a major role.

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What If You're Pregnant on a GLP-1?

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Every day, more women are getting pregnant while on GLP-1s. And because many don't know they're pregnant right away, they're using these medications into the first trimester.

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So the main question now has become: should you continue or should you stop?

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The current official stance is the following: you should stop the GLP-1 medication as soon as you find out you're pregnant. All major medical organizations agree on this.

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But let's look at what we actually know from the research:

• Exenatide (one of the older GLP-1s) does cross the human placenta, though at low levels.
• However, Liraglutide doesn't show significant placental transfer, but this was only monitored for a few hours.
• Animal studies with some medications show potential renal effects in later trimesters, but these haven't been replicated in humans.
• The largest study of over 50,000 pregnancies found no higher risk of major malformations when GLP-1s were compared to insulin in patients with diabetes.

Also, let’s consider most human studies are based on inadvertent use, which basically means we're looking back at patients who were pregnant and had first-trimester exposure because they didn't know they were pregnant yet or didn't know to stop.

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So basically: we don't know.

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What Happens When You Stop GLP-1s During Pregnancy?

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Here's where it gets really interesting.

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Let's say you're using Wegovy or Zepbound, you lose weight, and then you get pregnant and stop the medication. What happens during that pregnancy?

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Studies show that women who used GLP-1s before pregnancy had:

• More weight gain during pregnancy
• Higher risk of preterm delivery
• Higher rates of gestational diabetes
• Higher rates of high blood pressure in pregnancy

...compared to women who were pregnant and never used the medication.

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BUT CAREFUL HERE. This likely isn't from the medication effect itself.

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The patients who were on these medications probably started with a higher BMI to begin with. They may have already had prediabetes or elevated blood pressure — which is exactly why they were prescribed the medication in the first place.

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It could be that maintenance therapy or stepping down slowly is important long-term, but pregnancy eliminated that option. We have lots of thoughts here, but this is NOT a reason to continue GLP-1s during pregnancy without long-term studies.

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Where Do We Go From Here?

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The truth is, we're in the early days of understanding how GLP-1s affect pregnancy. What we're seeing in our practices is promising for fertility, especially for women with PCOS. But we need more research, longer studies, and better data on pregnancy outcomes.

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If you're on a GLP-1 and thinking about getting pregnant (or could become pregnant), this is a conversation to have with your doctor. Together, you can weigh the benefits you're experiencing against the unknowns and make the best decision for your situation.

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If you are already pregnant and want to know more about postpartum use of GLP-1s, click here.

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Book a 15-min FREE virtual consultation with us to discuss GLP-1s and fertility.

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And don't forget to visit our Services page to explore our care packages!

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This article provides general health information and should not replace personalized medical advice. Always consult with your healthcare provider about the best contraception method for your individual situation, especially when starting new medications.

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