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Warning: Rapid Rise in GLP-1 Prescriptions in Perinatal Care

•Posted inObstetrics and Gynaecology

The increasing global rates of obesity and type 2 diabetes have led to a significant surge in the use of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs), such as semaglutide and tirzepatide. Consequently, understanding the safety profile and prescribing patterns of GLP-1 in pregnancy and the postpartum period has become critically important. A recent retrospective cohort study in the US analyzed these prescribing trends from 2019 to 2024. The data reveals a concerning rapid adoption of these medications during the perinatal window.

Accelerated Adoption of Perinatal GLP-1 RAs

The study showed a sharp increase in the prevalence of GLP-1 RA prescribing. Specifically, predelivery prescribing rose dramatically from 0.2 to 6.4 per 1,000 deliveries. Also, postdelivery prescribing showed an even higher jump, accelerating from 0.3 to 14.6 per 1,000 deliveries. Researchers identified significant trend shifts indicating accelerated adoption. For instance, the predelivery prescribing rate accelerated in June 2022, while the postdelivery acceleration began earlier in March 2021. Therefore, these figures highlight a need for robust clinical action and patient counseling.

Prioritizing Safety and Counseling for GLP-1 in Pregnancy

Current international guidelines advise against initiating or continuing GLP-1 RAs during pregnancy due to limited human safety data. While some observational data suggest no increased risk of major congenital malformations from inadvertent early-pregnancy exposure, clinicians must maintain caution. However, animal studies indicate reproductive toxicity, including skeletal and visceral anomalies. Therefore, all individuals of child-bearing potential must use effective contraception while on these medications. Furthermore, because GLP-1 RAs can delay gastric emptying, the effectiveness of oral contraceptives may be reduced. Consequently, a barrier method should be added for four weeks after starting the drug or after any dose increase.

Preconception counseling is an essential step. Specialists recommend that patients discontinue semaglutide for at least 8 weeks and other GLP-1 RAs, like tirzepatide, for two months before attempting conception. For women requiring medication to manage diabetes during pregnancy, insulin remains the preferred treatment option. Metformin, for instance, is considered the most reassuring oral agent in terms of congenital risk.

The Need for New Real-World Evidence

The sharp increase in perinatal GLP-1 RA use underscores the urgent demand for comprehensive, evidence-based safety data. While large-scale pregnancy registries are currently being developed by manufacturers like Novo Nordisk and Eli Lilly, conclusive safety information will likely take several years to establish. Preliminary studies have begun to offer some insights. One large study of non-diabetic mothers suggested that babies born to mothers prescribed a GLP-1 RA in the 90 days before pregnancy were 21% more likely to require a Neonatal Intensive Care Unit (NICU) stay compared to controls. Also, other researchers found similar rates of congenital heart defects and failure to thrive in exposed and non-exposed groups. Nevertheless, GLP-1 RAs are large peptide molecules, and placental transfer is not expected to be significant. Ultimately, until more definitive human data is available, adherence to strict preconception and pregnancy guidelines is crucial for optimal maternal and fetal health.

Frequently Asked Questions

Q1: Why are GLP-1 RAs generally avoided during pregnancy?

GLP-1 RAs are avoided primarily due to a lack of sufficient human safety data. Animal studies have shown potential risks of fetal harm, which has led regulatory bodies to advise against their use during and immediately preceding pregnancy.

Q2: What is the current recommendation for discontinuing GLP-1 RAs before conception?

Healthcare providers recommend that patients discontinue GLP-1 RAs, such as semaglutide and tirzepatide, for a “wash-out” period, typically two months (or 8 weeks for semaglutide) before attempting to conceive, to ensure the drug has cleared the body.

Q3: Which medication is preferred for managing diabetes in pregnant patients?

Insulin is the preferred treatment for hyperglycemia in women with pre-existing or gestational diabetes. Metformin is also often considered a reassuring oral agent, but GLP-1 RAs are not recommended to be continued during pregnancy.

References

  1. Lessard C et al. Prescribing Trends in Glucagon-Like Peptide-1 Medications Among Pregnant and Postpartum Persons. Obstet Gynecol. 2026 Jan 08. doi: 10.1097/AOG.0000000000006161. PMID: 41505759.
  2. UK Teratology Information Service. USE OF GLP-1 RECEPTOR AGONISTS IN PREGNANCY. uktis.org.
  3. GOV.UK. GLP-1 medicines for weight loss and diabetes: what you need to know. Published 2025-08-20.
  4. CME India. GLP-1 Receptor Agonists in Pregnancy – What Physicians Need to Know? Published 2025-10-12.
  5. The BMJ. Ozempic babies: are weight loss drugs leading to unintended pregnancies? Published 2025-01-29.
  6. Pharmacy Times. Study Finds Similar Rates of Pregnancy in Women Who Were and Were Not Prescribed GLP-1 Medications. Published 2024-10-29.
  7. Epic Research. Increased Risk of NICU Stays for Babies Born to Mothers Prescribed GLP-1 Medications in the 90 Days Before Pregnancy. Published 2024-06-20.
  8. Dr. Oracle. What are the guidelines for using Glucagon-like peptide-1 (GLP-1) receptor agonists during pregnancy? Published 2025-09-16.
  9. Canadian Medical Association Journal (CMAJ). Glucagon-like peptide-1 receptor agonists during pregnancy and lactation. Published 2024-12-16.