How To Use Semaglutides Before Conception
When it comes to family planning decisions, they can often feel black and white. To try or not to try? What’s more, the decision to try to conceive often trumps whatever else is happening in your life at the moment—including whether or not to go on, or stay on, a weight loss drug like Ozempic.
The topic of weight loss drugs and pregnancy is a layered one. You may be asking yourself questions such as, is it worth going on a GLP-1 if you’re planning on trying for a kid in the next, say, six months? A year? Is it even safe? When would I have to wean off? Could I go back on a medication postpartum, or while breastfeeding?
For various reasons—including the health of the mother and baby—many experts say that the simple answer is yes, it is safe to go on a weight loss drug ahead of conception. “I always say [that] mom comes first before the baby, and her health is most important. So achieving an ideal weight is good for her health and for the baby’s health,” says Salli Tazuke, MD, a board-certified ob-gyn and reproductive endocrinologist and co-founder and co-medical director of CCRM Fertility in San Francisco.
But before going on a weight-loss drug like semaglutide (a.k.a. Ozempic when prescribed for diabetes, and Wegovy when prescribed for weight loss), it’s important to discuss your fertility plans with your doctor. Precise and individualized planning will be essential, doctors agree. WH spoke with experts to find out what you need to know about going on Ozempic when you want to have a baby—here’s what they shared.
Meet the experts: Salli Tazuke, MD, is a board-certified ob-gyn and reproductive endocrinologist and is the co-founder and co-medical director of CCRM Fertility in San Francisco. Carrie Burns, MD, is a board-certified endocrinologist and director of diabetes in pregnancy at Penn Medicine in Philadelphia. Vinni Makin, MD, is an endocrinologist at Cleveland Clinic in Ohio.
No, you can’t go on a weight loss drug if you’re already pregnant.
For a drug to be approved for the pregnant population, it must go through rigorous testing with that population, and that has not yet happened for semaglutide or other GLP-1 (glucagon-like peptide 1) agonists, says Carrie Burns, MD, a board-certified endocrinologist and director of diabetes in pregnancy at Penn Medicine in Philadelphia. However, in animal testing, semaglutide has been linked with negative side effects. Researchers studying the impact on pregnant mice, for instance, noted decreases in both fetal body weight and in the activity of various nutrient transporters in the placenta (meaning the fetus wasn’t getting the proper amount of vital nutrients). Animal studies have also shown a link to higher rates of miscarriage.
Of course, “Humans are different from rats, mice, and monkeys—but in animal studies it did not look safe,” Dr. Burns says, adding that the levels of semaglutide administered in these animal studies were at “toxic levels,” and not what a person prescribed a weight loss drug would be taking. Nonetheless, “until there’s better human study, it is not approved,” Dr. Burns says.
Large-scale human studies could be a long time coming given the risks associated with exposing a pregnant woman (and her fetus) to a potentially harmful drug. (One small prospective study of early pregnancy GLP-1 users in a handful of European countries and Israel, published recently in BMJ Open, found no increase in major birth defects or pregnancy loss, when compared with control groups of pregnant women with diabetes and pregnant women who are obese. But larger studies would be needed to validate these results.) At this point, researchers are working to study the drug’s effects retrospectively by establishing a pregnancy registry that collects data on women who were exposed while unknowingly pregnant. (Wegovy, a semaglutide that is approved for weight loss, has already established such a registry.)
In the scientific literature, there’s at least one such retrospective case of a woman who didn’t know she was pregnant taking semaglutide up until about the fourth week of her pregnancy. According to the paper published in the International Journal of Gynecology & Obstetrics, the woman delivered a baby girl who was otherwise healthy except for hypoglycemia (low blood sugar). The delivery itself was also complicated by shoulder dystocia (when one or both shoulders don’t easily clear the birth canal), but neither of those issues could directly be linked to semaglutide use.
Bottom line? Until there’s more exhaustive data on the side effects of semaglutide on pregnant women and their fetuses, it’s simply not worth the risk.
A weight loss medication may help your chances of conception if you take it before you plan to start trying.
By now, you’ve probably seen the “Ozempic baby” headlines floating around the internet—stories of women becoming pregnant by surprise just months into taking a weight-loss drug. There are a number of reasons why this could be, experts say.
Polycystic ovary syndrome (PCOS) is the leading cause of female infertility, according to the Mayo Clinic, and for women who have been prescribed semaglutide to combat the associated weight gain, the drug could improve their overall fertility.
“We know in smaller studies that when women with PCOS take semaglutide, it increases the regularity of the menstrual cycle, the chances of ovulation, and the chances of pregnancies,” says Vinni Makin, MD, an endocrinologist at Cleveland Clinic in Ohio.
For obese women who don’t have a PCOS diagnosis, a reduction in weight, in and of itself, may also boost their chances of conceiving, says Dr. Tazuke, as extra pounds can sometimes interfere with regular menstrual cycles.
There may also be another, surprising reason for the fertility boost, Dr. Makin says. Tirzepatide—semaglutide’s GLP-1 cousin known by its brand names Mounjaro and Zepbound—can reduce the effectiveness of oral hormonal birth control. The Food and Drug Administration (FDA) advisory notes that female patients should switch to a non-oral contraceptive (think: IUD) or use a second, barrier-type protection (such as a condom) to prevent pregnancy while on the drug.
Losing weight ahead of conceiving could also help pregnancy, labor, and delivery go smoother, Dr. Burns says. “We know obesity during a pregnancy increases the risk of hypertension, gestational diabetes,the likelihood of C-section, and liver injury,” she says. “If we can get the weight down before pregnancy, or in between pregnancies, that’s a great idea.”
If you want to start trying to conceive, here’s what to consider.
Even if you won’t start trying for months or even a year, it’s important to have a conversation with your doc to establish a plan, including a timeline, Dr. Burns stresses. This goes for anyone currently on a weight loss drug or who is considering going on one.
Semaglutide has a long half-life, meaning it lingers in the body even after you’ve stopped taking it. It’s recommended women be off the drug for two months before attempting to conceive. So if you know you want to start trying for a baby in June, for instance, your doctor will likely recommend halting your semaglutide doses by the end of March and continuing with your contraceptive use through April and May. At the beginning of June, you should be able to safely discontinue birth control use to begin trying for a baby.
Consulting your health care provider becomes even more critical if you’re taking a GLP-1 for diabetes, as you’ll likely need to be prescribed a replacement blood-sugar regulating drug, such as insulin (which is safe to use during pregnancy). “We’ll get you on a stable insulin regimen before you conceive because we want those blood sugars good at the time of conception—that’s really important,” Dr. Burns says. Medication modification will likely be accompanied by a conversation about lifestyle factors, such as eating and exercise.
How you get off the medication will depend on your unique situation—some patients slowly taper (or titrate) off over the course of weeks or months, while others simply stop cold turkey. Dr. Makin, for one, has used both methods in her practice. While there’s no real health risk to simply stopping the medication, titrating can be beneficial for many patients.
“For someone taking semaglutide for their weight and experiencing appetite suppression, if you titrate them off slowly, they can adjust to that appetite coming back and have time to make lifestyle changes versus if you stop somebody cold turkey, that appetite is going to come roaring back and they’ll have no time to make lifestyle adjustments,” Dr. Makin says. The same logic holds for titrating a diabetes patient off of semaglutide—easing that transition allows for time to regulate blood sugar levels and likely introduce a new diabetes medication into their regimen.
The most common side effect of stopping semaglutide is weight regain (another reason to discuss diet and exercise ahead of time with your doc!). But there’s also a ripple effect to be mindful of, says Dr. Makin. “If patients saw a significant amount of weight loss and saw their joint pains improve, or their sleep apnea improve [because of it], all of those comorbidities will get worse as the weight comes back,” she says.
When can you safely go back on semaglutide after pregnancy?
While research is still emerging about how much—if any—semaglutide passes through breast milk to baby, doctors recommend women stay off of GLP-1 drugs until they are done breastfeeding.
Once done breastfeeding, a woman, in consultation with her doc, can go back on semaglutide—slowly. “She’ll need to start with the smallest dose again, even though she might have tolerated the highest or the higher dose prior to the pregnancy,” Dr. Makin explains. “The GI system does not take well to the higher doses without a slow titration.”
Resuming a semaglutide regimen—while minding important lifestyle factors too!—is one way you can help prepare your body for future babies as well.
Amy Wilkinson is an entertainment editor who also specializes in health and wellness. When not editing or writing, she can be found teaching Pilates as a comprehensively certified instructor.
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