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A big international team looked at the evidence and put together recommendations about using GLP-1 receptor agonists — the class of drugs that includes medicines like semaglutide (Ozempic/Wegovy) — around the time of pregnancy. They reviewed studies, pooled data where possible, and then had experts weigh in to form a consensus about whether these medicines should be used before conception, during pregnancy, or while breastfeeding in women with type 1, type 2, or gestational diabetes. GLP-1 receptor agonists are drugs that act like a natural hormone your gut releases after you eat. In plain terms, they help lower blood sugar, slow how fast the stomach empties, and often reduce appetite so people lose weight. They are commonly prescribed for type 2 diabetes and, more recently, for weight management. But they are not standard treatment for type 1 diabetes, and their safety in pregnancy has been unclear. What the review found is that the direct human evidence in pregnancy is limited. Most studies are small or observational, and randomized trials in pregnant women are largely absent for this drug class. Some data come from pregnancies that happened while people were taking these drugs before they knew they were pregnant. Animal studies have shown potential risks at high doses, and human case reports have raised concerns, but the pooled human data don’t give a clear-cut answer. Because of the limited and mixed evidence, the international experts tended to be cautious: they generally advise stopping GLP-1 drugs when trying to conceive or as soon as pregnancy is confirmed, and they recommend against routine use during pregnancy until more robust safety data exist. Why this matters: many people of childbearing age take GLP-1 medicines for diabetes or weight. If someone is planning pregnancy or becomes pregnant, they and their clinicians need clear guidance about whether to continue the drug, switch to alternatives, or monitor differently. For people with diabetes, keeping blood sugar well controlled during pregnancy is important for the health of both mother and baby, so knowing which medications are safe and effective is critical. Important caveats: the consensus reflects limited evidence and expert opinion, not definitive proof. The drugs are not approved for use in pregnancy, and potential risks to the fetus are not fully known. Side effects in non-pregnant people include nausea, vomiting, and rarely more serious issues like pancreatitis. Women who are pregnant, planning pregnancy, or breastfeeding should discuss medication plans with their doctor; clinicians may favor established diabetes treatments with known pregnancy safety profiles. Regulatory guidance and new studies could change these recommendations as more data appear. Bottom line: Experts recommend caution — stop GLP-1 receptor agonists when trying to conceive or once pregnancy is confirmed, because the evidence about safety in pregnancy and breastfeeding is limited and inconclusive.
Source: The Lancet