On October 23, the American College of Obstetricians & Gynecologists (ACOG) released long-awaited guidance that will help ob-gyns counsel patients on the use of GLP-1 medication before, during, and after pregnancy.
Given how prevalent the use of GLP-1s has become, especially among women of reproductive age, ACOG’s Practice Advisory: “Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation” offers recommendations for clinicians who are helping their patients navigate its use during pregnancy when little data exists.
“Currently, as many as 1 in 300 women are exposed to GLP-1s prior to pregnancy,” said D. Yvette LaCoursiere, MD, FACOG, lead author of the guidance. “In addition to getting prescriptions from their clinicians, these medications are now widely accessible through online providers and medical spas. This means the likelihood of exposure in pregnancy is heightened, and there isn’t enough data available at this point to know what effects the medication will have on the pregnancy or the fetus. This is a fast-moving area of research, so for now we need to proceed with caution and reassess as more data becomes available.”
According to ACOG’s guidance, OB-GYNs and other health care professionals should advise their patients about the lack of sufficient safety data regarding GLP-1 use in pregnancy and recommend that their patients consider discontinuation one to two months prior to pregnancy. Most GLP-1 medications have long half-lives, meaning it can take several days or weeks for the body to clear the medication after a patient has stopped taking it. The guidance also recommends against GLP-1 use for the duration of the pregnancy and includes a table that lists all the GLP-1 medications and information on their half-lives.
The guidance states that in animal studies, use of GLP-1 medications in pregnancy was associated with decreased fetal weight, growth restriction, abnormal development of bone tissue, and less maternal food consumption and weight gain. However, it’s believed that due to the makeup of GLP-1s, transplacental passage is unlikely, and, to date, available human data have not demonstrated a consistent increase in birth defects. But safety data remains limited, and additional research is needed when it comes to the indirect effects of the medication and newer agents that are constantly coming on the market.
One study suggests that prepregnancy GLP-1 use may be associated with lower rates of gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and cesarean delivery, but findings remain mixed and additional research is needed. 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.
“While patients often experience the positive effects of GLP-1s prior to pregnancy, there are risks associated with both taking the medication and discontinuing that people should consider,” said Amy Valent, DO, FACOG, chair of ACOG’s Clinical Consensus Committee–Obstetrics. “Unfortunately, regaining lost weight is common and may increase the risk of adverse outcomes linked to obesity and excessive gestational weight gain. Therefore, ACOG encourages clinicians to monitor their patient’s weight and counsel them on incorporating lifestyle interventions such as healthy and diversified eating habits, nutrition referral, regular physical activity, and behavioral support.”
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. It is unclear how taking GLP-1 medications in the postpartum period while breastfeeding affects milk volume, nutritional density, or composition—all of which contribute to infant growth. ACOG recommends that OB-GYNs engage in shared decision-making with their patients to create a care plan that can potentially include GLP-1s but recommends against use during lactation for infants within the first 28 days of life and for preterm infants.
“While GLP-1s are unlikely to be present in breast milk based on early data, there is not adequate safety data or information on the long-term effects. ACOG is recommending that ob-gyns advise lactating patients about these uncertainties. For those who ultimately choose to use GLP-1s despite limited data, it is prudent to select the ones with shorter half-lives and closely monitor their infant’s weight gain,” said Dr. LaCoursiere.
As research on GLP-1 medications continues to evolve, ACOG will monitor emerging evidence and update guidance as needed. You can read more with ACOG’s Practice Advisory: “Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation.”
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