- A recent study suggests that stopping GLP-1s before pregnancy may be linked to higher rates of complications and excessive gestational weight gain.
- Experts caution that the findings don’t necessarily prove causation and that underlying obesity and metabolic conditions are likely contributing factors.
- GLP-1 medications prescribed for weight loss are not recommended during pregnancy.
- Experts advise focusing on balanced nutrition, gentle physical activity, and other strategies to support healthy pregnancy weight gain.
New research has found that using GLP-1 drugs like Ozempic before pregnancy could influence certain pregnancy outcomes. However, more research is needed.
A recent study published in
Within that group, researchers identified roughly 450 pregnancies in which the parent had used a GLP-1 medication at some point between the three years leading up to conception and the first 90 days afterward.
About half of the female participants had their last GLP-1 medication order within six months of conceiving, around one-third had their last order earlier than that, and about 17 percent had their last GLP-1 medication order beyond conception.
To assess outcomes, the researchers compared them with a second group of individuals who had never taken a GLP-1 medication but had similar prepregnancy BMIs.
In both groups, BMI values spanned from healthy to severely obese, and the proportion of people in each BMI category was comparable.
They also gained more weight during pregnancy, averaging about 30 pounds (13.7 kilograms), compared with roughly 23 pounds (10.5 kilograms) in the comparison group.
Importantly, a greater share of the GLP-1-exposed group experienced what is considered excessive gestational weight gain, a pattern linked with health risks for both parent and baby.
Andrea Braden MD, board certified OB-GYN, told Healthline it’s important to note the limitations of this research.
“This study raises important questions, but it does not prove that GLP-1 medications directly cause harm in pregnancy. The people who need these drugs often have obesity or diabetes, which already increases the risk of complications,” she explained.
“It’s a classic case of confounding by indication, and we need much better, pregnancy-specific research before drawing firm conclusions.”
Shyamala Vishnumohan, PhD, a prenatal dietitian at The Pregnancy Dietitian, told Healthline that the results of this study don’t surprise her.
“Those who need GLP-1s usually have significant obesity and insulin resistance, and when the medication is withdrawn, it’s common to see appetite and blood sugars surge,” she said.
“The message is clear: we can’t just pull away a powerful weight-loss tool right before pregnancy without a transition plan.”
If you are planning to get pregnant, weighing the potential benefits and risks of GLP-1s on pregnancy outcomes is essential.
“These medications stay in the body for weeks, which is why current guidance suggests stopping GLP-1s at least two months before trying to conceive,” Braden explained.
“Stopping suddenly can lead to rebound weight gain or worse blood sugar control, both of which matter for pregnancy outcomes.”
In theory, better weight and blood sugar management could improve pregnancy outcomes and lower the risk of problems like preeclampsia, cesarean birth, or very large babies.
“GLP-1s clearly help metabolic health outside of pregnancy, and preconception use may set some patients up for a healthier pregnancy,” Braden noted.
“However, we do not have strong, prospective trials of GLP-1 therapy started or continued during pregnancy that show clear benefit and safety,” she warned.
We currently know much more about the potential risks of GLP-1 drugs on pregnancy outcomes.
“Most of our concern comes from animal data, where high-dose GLP-1 exposure has been linked to fetal growth restriction, structural abnormalities, and pregnancy loss, often alongside significant maternal weight loss,” Braden noted.
“That is why the drug labels tell us not to use these medications in pregnancy.”
Human data is more limited and mixed. “So far, we do not see a clear pattern of major birth defects, which is somewhat reassuring, but we lack robust information on more subtle outcomes and long-term effects on children,” Braden said.
“The biggest risk in my view is that we simply do not know enough, and families are being asked to make decisions in that uncertainty.”
Vishnumohan added that GLP-1 use could cause side effects like nausea and poor appetite that could drive under-nutrition in a period of higher nutrient needs.
Weighing the pros and cons of GLP-1 use before pregnancy can be tricky when you consider that overweight and obesity can also negatively impact pregnancy outcomes.
In this context, do experts believe the benefits of taking GLP-1 drugs outweigh the risks?
“I wouldn’t frame this as ‘GLP-1s versus obesity’,” Vishnumohan said. “Obesity and metabolic disease are still the main drivers of pregnancy risk, and GLP-1 use plus abrupt discontinuation may simply add an extra layer of risk or instability on top.”
Vishnumohan said that obesity and metabolic health ought to be treated before pregnancy. She said that better systems are needed to support those stopping these weight loss medications so that one risk is not exchanged for another.
In Braden’s view, we currently know far more about the risks of obesity in pregnancy than we do about the risks of GLP-1 exposure.
“Prepregnancy obesity and excess gestational weight gain are consistently linked to gestational diabetes, hypertensive disorders, cesarean birth, and long-term metabolic risks for the child,” she said.
GLP-1-related risks are much less defined. “Some of the higher risk seen in recent studies likely reflects the underlying obesity and metabolic disease that led to the medication in the first place, along with rebound weight gain after stopping,” Braden noted.
“I do not think the potential benefits of taking GLP-1 medications during pregnancy outweigh the unknowns right now, especially when we have alternatives like insulin that have a much longer safety track record,” she said.
GLP-1 drugs are not recommended during pregnancy, and there are other, safer ways to maintain a healthy weight.
“When you’re pregnant, the goal is nourishment and to focus on gaining the appropriate amount of weight from your starting BMI, not zero weight gain,” Vishnumohan said.
“Focus on regular meals and snacks, building plates with proteins, high fiber carbs, color from vegetables and fruits, and a little healthy fat,” she added.
Exercise can be incredibly beneficial, too. “Add ‘movement snacks’ to your day; short bouts of gentle activity like walking after meals, climbing a few stairs, or completing simple resistance moves spread throughout the day, if medically appropriate,” Vishnumohan continued.
“Just as important is looking after your stress, sleep, and nausea because they can drive our eating behaviour,” she said.
Professional support can also be helpful.
“We have good evidence that structured behavioral counseling in pregnancy, focused on nutrition and physical activity, can reduce excess gestational weight gain and lower the risk of gestational diabetes, emergency cesarean birth, and very large infants,” Braden explained.
Bottom line, Vishnumohan said that there’s no such thing as a “perfect” pregnancy diet or “perfect” exercise routine. Rather, she recommended aiming for nutrition and lifestyle habits that are healthy and practical.
