New Guidance on GLP-1 Use Before, During, and After Pregnancy: What Clinicians Need to Know
As GLP-1 receptor agonists become increasingly popular for weight management and diabetes, their use among people of reproductive age has surged. In response, new guidance has been issued to help clinicians navigate the complexities of GLP-1 use before, during, and after pregnancy. The guidance, a multidisciplinary collaboration spanning 23 institutions, offers a practical framework for contraception, preconception care, pregnancy, breastfeeding, and postpartum management. However, safety data remain limited, and additional research is needed to understand the indirect effects of these medications and newer agents that are constantly coming on the market.
One key insight is that prepregnancy GLP-1 use may be associated with lower rates of gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and cesarean delivery, according to one study. However, findings remain mixed, and more research is needed to confirm these potential benefits. Additionally, because GLP-1-associated weight loss may increase fertility, it’s important for ob-gyns to speak with patients who do not wish to become pregnant about reliable contraception. The guidance emphasizes that these medications should be discussed in the context of a patient’s reproductive plans before they are prescribed—not only once a pregnancy occurs.
GLP-1 medications may result in inadequate intake of nutrient-dense foods that are especially important before, during, and after pregnancy, increasing the risk of vitamin and mineral deficiencies in the patient and fetus. Although early observational studies have not demonstrated a clear increase in major congenital malformations following inadvertent first-trimester exposure, the available data remain limited and do not establish safety for continued use throughout pregnancy. This is particularly important for patients with type 2 diabetes, for whom glucose should be actively monitored and alternative treatment promptly titrated before conception.
The new guidance identifies critical knowledge gaps and offers practical recommendations for clinicians. The key message is that GLP-1 medications should be considered within the context of a patient’s reproductive life plan. As these drugs are used more frequently by people of reproductive age, it is essential for healthcare providers to stay informed and engage in shared decision-making with their patients. While the potential benefits of GLP-
Shimanta Das 
