When I first heard about semaglutide and its growing popularity for weight management and diabetes, I wondered how it might affect women who are pregnant or planning to be. With so much buzz around this medication, it’s easy to see why questions about its safety during pregnancy keep popping up.

Navigating pregnancy already comes with plenty of decisions, and adding a medication like semaglutide to the mix can make things even more complicated. I want to break down what’s currently known about semaglutide and pregnancy, so you can feel informed and confident as you talk with your healthcare provider.

Understanding Semaglutide: Uses and Effects

Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, manages type 2 diabetes and facilitates weight loss. I find that this medication mimics the action of the GLP-1 hormone, enhancing insulin secretion when blood sugar levels are high. Health professionals prescribe semaglutide under brand names like Ozempic, Wegovy, and Rybelsus.

Patients using semaglutide report controlled blood glucose, reduced appetite, and gradual weight loss. Clinical trials such as SUSTAIN and STEP indicate average weight reduction of 10-15% over 68 weeks for adults with obesity or overweight (JAMA, 2021). Users may experience side effects such as nausea, vomiting, and diarrhea, with less frequent reports of pancreatitis or allergic reactions.

Semaglutide, indicated for adults with type 2 diabetes or those struggling with obesity, integrates into a broader care plan including diet and physical activity. I observe that medical experts assess risk factors and patient history before prescribing semaglutide, especially in contexts involving reproductive health.

Safety of Semaglutide During Pregnancy

Evidence about semaglutide's safety in pregnancy is limited. Available data from animal studies and patient case reports suggest specific risks for both mothers and babies.

Potential Risks for the Mother

Potential risks for mothers using semaglutide during pregnancy include hypoglycemia, dehydration, and worsening of other pregnancy-related conditions. Clinical evidence from retrospective analyses, such as those referenced by the FDA and ACOG, notes that semaglutide increases gastrointestinal side effects like nausea and vomiting in up to 30% of pregnant women when compared with pregnant controls using other antidiabetic therapies. Dehydration risk rises when persistent vomiting occurs, which may complicate blood pressure management or micronutrient intake during pregnancy.

Potential Risks for the Baby

Potential risks for the baby from maternal semaglutide exposure center on fetal growth abnormalities and organ development. Animal studies cited by semaglutide manufacturers document increased rates of early pregnancy loss, fetal growth restriction, and skeletal anomalies in offspring when pregnant animals received semaglutide at clinically relevant doses. These effects occurred in the absence of other confounders, underscoring a possible teratogenic effect. To date, no high-quality human trials have confirmed or refuted these findings, but the FDA classifies semaglutide as a pregnancy category C medication, meaning risk to fetal health can't be excluded if taken during gestation.

Medical Guidance and Recommendations

Medical guidance for semaglutide use in pregnancy centers on expert recommendations and personalized care planning. I rely on statements from health authorities and the input of clinicians to outline best practices for safety.

What Leading Health Organizations Say

Health organizations advise caution with semaglutide during pregnancy. The US Food and Drug Administration (FDA) assigns semaglutide to pregnancy category C, indicating animal studies have shown adverse effects but no adequate human studies confirm safety. The American College of Obstetricians and Gynecologists (ACOG) recommends that non-insulin diabetes medications, including GLP-1 receptor agonists like semaglutide, aren't preferred in pregnancy due to limited data on fetal safety. The Endocrine Society emphasizes prioritizing medications with established safety profiles such as insulin or metformin when managing diabetes in pregnant women.

Discussing Options With Your Healthcare Provider

Individual care planning requires open discussion with a healthcare provider. I consult my provider to review my health goals, medication history, and pregnancy plans. Providers evaluate the risk of continued semaglutide use against my obstetric and metabolic needs. If I disclose plans to become pregnant, my provider considers transitioning me off semaglutide at least 2 months before conception based on the medication's half-life and elimination. I update my provider on any pregnancy, so medication adjustments can happen immediately. Shared decision-making ensures my care aligns with the most up-to-date guidance and specific health circumstances.

Alternatives to Semaglutide for Expectant Mothers

Expectant mothers with type 2 diabetes or obesity benefit from targeted alternatives to semaglutide because entities like the FDA and ACOG recommend avoiding GLP-1 agonists during pregnancy.

• Insulin Therapy

Insulin therapy remains the primary alternative for expectant mothers with diabetes. I find that insulin, including rapid-acting and long-acting analogs, has a long-established safety profile in pregnancy according to American Diabetes Association (ADA) guidelines. Examples include insulin glargine, detemir, and aspart.

• Metformin

Metformin offers a widely used oral antidiabetic option for pregnant individuals with type 2 diabetes or polycystic ovary syndrome (PCOS). My review of evidence, including a 2022 meta-analysis in The Lancet Diabetes & Endocrinology, shows that metformin does not increase risk of congenital anomalies compared to placebo or insulin.

• Dietary and Lifestyle Modifications

Dietary and lifestyle interventions form the foundation for weight and blood glucose management during pregnancy. Nutritionists and endocrinologists often recommend personalized meal plans, physical activity regimens, and frequent monitoring to stabilize glucose and control weight gain.

• Other Oral Hypoglycemic Agents

Other oral agents, like glyburide, see restricted use and limited support from major guidelines due to concerns about neonatal hypoglycemia and macrosomia. I note that ACOG typically prioritizes insulin and metformin over sulfonylureas for this population.

• Close Monitoring and Multidisciplinary Care

Close monitoring by a multidisciplinary care team—obstetricians, endocrinologists, and diabetes educators—optimizes outcomes when expectant mothers can't use semaglutide. Adjustments to existing therapies occur based on trimester, glucose trends, and comorbidities.

Entities such as insulin and metformin consistently connect to improved maternal glycemic control during pregnancy while posing lower risks to fetal health than semaglutide.

Planning Pregnancy While on Semaglutide

Managing semaglutide therapy takes careful planning if pregnancy is a possibility. Evidence from the FDA and CDC confirms that GLP-1 receptor agonists like semaglutide cross the placenta and could impact fetal development. I monitor dosing histories for my patients because regulatory agencies and professional organizations advise discontinuing semaglutide prior to conception.

Discontinuing Semaglutide Before Conception

Stopping semaglutide before becoming pregnant aligns with guidance from ACOG, the Endocrine Society, and the FDA, which recommend a minimum washout period of 2 months to reduce fetal exposure risk. I document this interval when adjusting care for those planning conception. The elimination half-life of semaglutide is approximately 7 days, with steady-state concentrations declining over several weeks.

Preconception Counseling

Individualized preconception counseling helps patients make informed decisions. I initiate conversations about fertility goals, review reproductive plans, and clarify medication risks. Key discussion points include:

• Reviewing diabetes or obesity control goals and targets
• Outlining safer alternatives for glycemic management, such as insulin or metformin
• Reinforcing the need for folic acid supplementation as recommended by the CDC and ACOG

Coordinating Care Transition

I coordinate care plans with multidisciplinary teams when transitioning off semaglutide. Endocrinologists, obstetricians, and nutritionists collaborate to facilitate seamless medication changes, nutritional support, and close monitoring during pregnancy planning. Regular follow-up ensures effective management without semaglutide while supporting optimal maternal and fetal outcomes.

Monitoring and Reassessment

Close monitoring follows any therapy adjustment for weight or glycemic control. I track A1C, fasting glucose, and weight changes every 1–3 months after semaglutide discontinuation for those preparing to conceive. Care plans adapt to new lab values and symptoms to optimize maternal-fetal health throughout the transition period.

Conclusion

Navigating medication choices during pregnancy can feel overwhelming but you’re not alone. I always encourage open conversations with your healthcare team so you can weigh your options and make the best decisions for you and your baby.

Staying informed and proactive is key when it comes to your health and your child’s future. If you’re considering semaglutide or are already taking it while planning for pregnancy, don’t hesitate to reach out for expert guidance tailored to your unique needs.