Guidelines on Navigating GLP-1 Medications Before, During, and After Pregnancy

By Irene Yeh 

As incretin-based medications, including glucagon-like peptide-1 receptor agonists (GLP-1RAs) or glucose-dependent insulinotropic polypeptide (GIP) drugs, become increasingly common in obesity and weight management, questions remain about their use throughout a woman’s reproductive years. Although these medications can reduce appetite and promote weight loss, they are currently not recommended during or after pregnancy because animal studies have raised concerns about potential effects on fetal development. Evidence on how these drugs may affect fertility, pregnancy, nutrition, and breastfeeding remains limited, leaving clinicians with few clear guidelines for managing treatment when patients are planning pregnancy, become pregnant, or are postpartum. 

To address these gaps, an international multidisciplinary group of researchers from the U.S., Europe, and the Middle East reviewed the available evidence and developed clinical recommendations for women of reproductive potential that may be using incretin-based medications. The findings, published in Obesity Reviews (DOI: doi.org/10.1111/obr.70203), provide guidance for clinicians while highlighting unanswered questions about the medications’ use before, during, and after pregnancy. 

“The rapid adoption of GLP-1 medications has outpaced the evidence available for women who are planning pregnancy or become pregnant,” said Shahrad Taheri, professor and vice dean for adiposity-based chronic diseases at the Marshall University Joan C. Edwards School of Medicine, in a press release.  

Reviewing the Evidence 

The team searched studies written in English from any date up to July 23, 2025 (when the study occurred), with priority on human studies over animal studies. After screening 41,339 articles from databases, they reviewed 34 studies in the final evidence analysis, including randomized trials, observational studies, pharmacovigilance analyses, and case reports. The studies were from several different countries, including the U.S., Australia, and countries in Europe and the Middle East. 

The researchers aimed to address questions on fertility, pregnancy (fetal and maternal considerations), breastfeeding, and postpartum health. In the analyses, the evidence suggested that women with polycystic ovary syndrome (PCOS) and obesity may benefit from incretin-based drugs, as GLP-1 receptor agonists may particularly help with ovulatory potential through metabolic and endocrine optimization. It was also found that tirzepatide may reduce the effectiveness of birth control absorption.  However, there was a noticeable evidence gap that emphasized the urgent need for more research in this area.  

Best Practice Recommendations 

The team created a list of best practice recommendations for women of reproductive age before, during, and after pregnancy. While these recommendations are not based on the highest evidence level classification, they were considered by expert consensus as having the best potential impact on care. 

• Contraception: Women using incretin-based medications should receive counseling on reliable contraception. Those taking tirzepatide should use a reliable non-oral contraceptive method. 

• Pregnancy planning: Women should be proactively counseled about the risks of becoming pregnant while taking incretin-based medications. There is currently no clear evidence for a specific washout period. If pregnancy occurs, the medication should generally be stopped once pregnancy is confirmed. 

• Nutrition: Women taking these medications should receive dietary and physical activity guidance to maintain adequate nutrition and reduce the risk of nutrient deficiencies. A protein- and fiber-rich diet, adequate hydration, and appropriate vitamin and mineral supplementation should be considered, particularly for women planning pregnancy. Support should also be provided to help prevent weight regain after stopping treatment. 

• Who should receive treatment: Treatment may be particularly beneficial for women with a higher metabolic risk, including those with obesity, PCOS, obesity-related health conditions, or specific fertility treatment needs. 

• Pregnancy: Incretin-based medications should not be intentionally continued during pregnancy. However, women who are accidentally exposed early in pregnancy can be counseled that current evidence has not shown an increased risk of birth defects. 

• Pregnancy monitoring: Women who have been exposed to these medications during pregnancy should receive appropriate monitoring of fetal growth and maternal weight gain. Blood glucose testing should follow national guidelines, with additional early testing considered after inadvertent exposure. 

• Breastfeeding: Due to limited evidence on the safety of incretin-based medications during breastfeeding, decisions should be made individually by weighing the benefits of breastfeeding against the potential risks to the infant. If treatment is used, infant growth and development and the mother’s nutritional status should be monitored. 

• Postpartum treatment: Incretin-based medications may help women with a history of gestational diabetes manage weight and blood glucose after pregnancy. However, the best time to restart treatment remains unclear and should take breastfeeding into account. 

• Multidisciplinary support: Women of reproductive age taking incretin-based medications should have access to a multidisciplinary care team, including a registered dietitian, particularly when planning pregnancy and during the postpartum period. 

More Research Needed 

Though the team came up with a list of best practices, they noted new evidence is likely to emerge due to the rapidly evolving field of incretin-based medications. Furthermore, 14 out of the 32 research questions (43.8%) could not be answered due to lack of sufficient evidence, highlighting an urgent need to continue research in this area.  

Before conception, the research team recommends that studies should examine the medications’ influence on contraception, side effects, weight, blood sugar, and fertility, particularly among women with obesity and infertility. During pregnancy, researchers need to better understand whether the medications cross the placenta and how exposure at different stages of pregnancy may affect maternal nutrition, fetal growth, pregnancy outcomes, and infant health.  

More research is also needed after childbirth to determine whether the medications pass into breast milk and how they may affect infant growth and development, as well as the long-term health of both mothers and children. Researchers also called for studies examining the role of multidisciplinary care, healthcare professionals’ knowledge and training needs, and the experiences of women using these medications throughout the reproductive period. 

“This work represents an important step toward improving reproductive care for women living with obesity,” Taheri said. “As the use of these medications continues to grow, this guidance provides a foundation for clinicians and identifies important opportunities for future research.”