Semaglutide and Pregnancy: What the Evidence Says

Written By A. Hidalgo

Estimated reading time: about 3 minutes

Understanding GLP-1 medications, fertility, and maternal health

Semaglutide, a GLP-1 receptor agonist, is widely used in the management of obesity and type 2 diabetes. As more women of reproductive age use this medication, an important question arises: what do we know about semaglutide exposure before or during pregnancy?

A systematic review published in the European Journal of Obstetrics & Gynaecology and Reproductive Biology (EJOG) assessed fetal and neonatal outcomes associated with semaglutide exposure before or during pregnancy, with no language restrictions.

This article summarises the findings in clear, practical terms and explains what they mean for patients.

This information is for general education purposes and does not replace medical assessment, diagnosis, or personalised care from a healthcare professional.

Why this topic matters

Overweight and obesity affect a significant proportion of women of reproductive age and are known to influence fertility, pregnancy outcomes, and long-term health. While lifestyle interventions remain first-line, they are not always sufficient. As GLP-1 medications such as semaglutide are increasingly used for weight management, questions about fertility, pregnancy and breastfeeding are becoming more common.

Semaglutide is therefore sometimes used before conception to improve metabolic health. However, the medication has a long half-life and can remain in the body for weeks after stopping treatment. This raises concerns about unintentional early pregnancy exposure.

Current guidance recommends discontinuing semaglutide at least two months before attempting pregnancy.

What did the review examine?

The systematic review analysed five studies, covering 1,128 pregnancies exposed to semaglutide. These included:

  • National registry cohort studies

  • Pharmacovigilance database analyses

  • A detailed clinical case report

The primary outcome assessed was major congenital malformations (developmental abnormalities at birth), with secondary outcomes including miscarriage, preterm birth, preeclampsia, neonatal hypoglycaemia, and infant birth size.

Key findings

Congenital malformations

Studies so far have not shown an increased risk of birth defects in pregnancies exposed to semaglutide, although pregnancy safety data are still limited. However, the authors emphasise that absence of evidence is not evidence of safety, particularly given the limited number of cases.

Pregnancy and neonatal outcomes

Some studies reported higher rates of:

  • Preterm birth

  • Large-for-gestational-age infants

  • Neonatal hypoglycaemia

These outcomes may reflect underlying maternal conditions, such as obesity or diabetes, rather than a direct effect of semaglutide.

Miscarriage and hypertensive disorders

Findings related to miscarriage and preeclampsia were inconsistent, with low certainty due to reporting bias and limited adjustment for confounders.

What are the limitations?

The authors highlight important limitations:

  • All studies were observational

  • Sample sizes were small

  • Medication timing and dosage were inconsistently reported

  • Long-term child outcomes were not assessed

As a result, firm conclusions cannot yet be drawn, and further research is needed.

What does this mean for patients?

Current evidence does not show a consistent increased risk of major birth defects associated with semaglutide exposure. However, due to limited data, semaglutide is not recommended during pregnancy.

Anyone planning pregnancy, or who becomes pregnant while using GLP-1 medications, should seek medical advice promptly.

Because semaglutide stays in the body for several weeks, current medical guidance recommends stopping treatment at least 2 months before trying to conceive.

If pregnancy occurs while taking semaglutide, the medication should be stopped and medical advice sought promptly. Current evidence does not suggest automatic harm, but individual review is recommended. Semaglutide is not currently recommended while breastfeeding because there is not yet enough safety data regarding its effects on breast milk or babies.


Additionally, symptoms such as unintentional weight loss, persistent fatigue, or any other concerning symptoms should always prompt medical review.

A Beyondbmi perspective

At Beyondbmi, we recognise obesity as a complex, chronic, biological condition, not a lifestyle choice. Weight management, particularly before pregnancy, should prioritise metabolic health, hormonal balance, and long-term wellbeing, not appearance or numbers on a scale.

Our programme follows evidence-based clinical guidelines, with treatment decisions made only after full medical assessment.

If you would like to understand whether medical weight management may be appropriate for you, you can also check eligibility.

The bottom line

  • Semaglutide is not recommended during pregnancy because there isn’t yet enough evidence about its use in pregnancy,  not because harm has been shown.

  • No consistent increase in birth defects has been identified.

  • Semaglutide should still be avoided during pregnancy.

  • Individualised, medically guided care remains essential.

A. Hidalgo

Health Content Lead.

Medically reviewed and approved by Dr Noelle Quann, Medical Lead, Beyondbmi.

Next

What a Healthier Weight Means (And Why It’s Not About Appearance)