GLP-1 medications are not recommended during pregnancy, and ACOG advises considering stopping them 1 to 2 months before trying to conceive. Fertility can rise as weight changes, so effective contraception during treatment matters, and tirzepatide can reduce how well birth control pills work.
If you might want to become pregnant in the future, a GLP-1 medication can still be part of your plan, but timing and contraception matter. The American College of Obstetricians and Gynecologists (ACOG) advises against using these medications during pregnancy and suggests considering stopping them 1 to 2 months before trying to conceive, and the Wegovy label advises stopping semaglutide at least 2 months before a planned pregnancy. Because weight loss may make conception more likely, effective contraception during treatment is important. The early safety data after accidental exposure are broadly reassuring, but they are not enough to call these medications safe in pregnancy.
ACOG's 2026 advisory notes that some studies show improved spontaneous and assisted fertility with GLP-1 medications, and that a 2022 randomized trial found higher spontaneous conception rates with exenatide than with metformin in women with obesity and infertility. ACOG concludes that because GLP-1-associated weight loss may increase the likelihood of conception, people who can become pregnant should be counseled about effective contraception while using these medications.
That does not make GLP-1 medications a fertility treatment. ACOG notes that a 2021 Cochrane review found insufficient evidence to recommend medication for women with obesity and infertility, and that there are not enough safety data to recommend intentionally conceiving while on a GLP-1 medication.
Two practical points come straight from the labels and the advisory:
If you are unsure which method fits your plan, raise it at your first visit rather than after treatment has started.
| Stage | What to cover with your provider |
|---|---|
| Before starting | Whether pregnancy is possible in the next year or two, and which contraception you will use |
| During treatment | Reliable contraception; the oral contraceptive adjustment if you take tirzepatide |
| Planning to conceive | Stopping 1 to 2 months ahead (ACOG), or at least 2 months ahead for semaglutide (Wegovy label); folic acid; a plan to hold steady after stopping |
| If pregnancy happens | Stop the medication and contact your clinician promptly |
| After birth | Whether and when to restart, including if you are breastfeeding |
Most GLP-1 medications stay in the body for a long time. ACOG points out that the long half-lives of semaglutide, tirzepatide and dulaglutide make avoiding exposure in early pregnancy more challenging, which is why stopping ahead of conception is advised rather than at the first positive test.
ACOG is candid that stopping carries its own risk: weight regain is common after these medications are discontinued, and regaining weight may increase obesity-related pregnancy risks and lead to faster weight gain during pregnancy. It encourages weight monitoring and support with healthy eating, regular exercise, dietitian referral and behavioral support as needed. Our article on ongoing weight management covers what that support can look like.
The CDC recommends that anyone who could become pregnant get 400 micrograms of folic acid every day to help prevent neural tube defects, which develop in the first weeks of pregnancy, often before a person knows they are pregnant. This applies whether or not you are taking a GLP-1 medication.
Both the Wegovy and Zepbound labels say to stop the medication when pregnancy is recognized, and the Wegovy label notes that weight loss offers no benefit during pregnancy and may cause fetal harm. ACOG likewise advises against GLP-1 use for the rest of the pregnancy. Contact your clinician, and be ready to share when you last took the medication.
What do the human data show so far? A 2024 study in JAMA Internal Medicine followed more than 50,000 pregnancies in women with type 2 diabetes across the Nordic countries, the US and Israel. Among 938 infants exposed to GLP-1 medications around conception or in the first trimester, the risk of major congenital malformations was not higher than among infants exposed to insulin (adjusted relative risk 0.95, with a 95 percent confidence interval of 0.72 to 1.26). The authors called the results reassuring but imprecise and said confirmation from other studies is needed.
ACOG's 2026 review of four recent meta-analyses reached a similar conclusion: these analyses did not show statistically significant increases in major malformations, pregnancy loss, preterm birth or several other outcomes, but they rely on a limited number of observational studies and cannot establish safety. Animal studies have shown effects such as reduced fetal weight and growth, which is part of why caution is advised.
The Zepbound label encourages anyone exposed during pregnancy to enroll in its pregnancy registry by calling 1-844-524-0039, which helps researchers learn more.
ACOG's advisory takes a shared decision-making approach to lactation. A postpartum plan may include a GLP-1 medication, and if one is used while breastfeeding, close monitoring of the baby's weight gain with the infant's care team is recommended. ACOG recommends against use when breastfeeding preterm infants or newborns. The Zepbound label reports that tirzepatide levels in breast milk were undetectable or low, but there are no data on effects in the breastfed infant or on milk production.
ACOG observes that unapproved compounded GLP-1 formulations are widely available online, including in low "microdose" amounts. None of these products were studied in pregnancy. Compounded medications are not FDA-approved, and the FDA states it does not review them for safety, effectiveness or quality before they are marketed. The same planning steps apply: reliable contraception, stopping ahead of conception, and stopping right away if pregnancy occurs.
ACOG advises considering stopping 1 to 2 months before conception, and the Wegovy label specifies at least 2 months for semaglutide because it stays in the body for a long time. Your prescriber can tailor timing to the specific medication you use. Ideally, make the plan before you stop contraception.
Tirzepatide can reduce the effectiveness of oral hormonal contraceptives, so its label advises switching to a non-oral method or adding a barrier method for 4 weeks after starting and after each increase. Separately, weight loss may raise the chance of conceiving. Discuss your method with your provider at the start.
Stop the medication and contact your clinician promptly. Current observational data have not shown a large increase in major birth defects after early exposure, which is reassuring, but the data are limited. Your obstetric team can talk through what the timing means for you.
ACOG says this can be a shared decision for some people, with close monitoring of the baby's weight gain, and recommends against it when nursing preterm infants or newborns. Data on breastfed infants are limited. Talk with both your own clinician and your baby's.
The best time to talk about pregnancy is before you start treatment, even if pregnancy feels far off. A licensed provider can help you choose contraception, set a timeline for stopping, and plan support for the months that follow. If you have severe symptoms during pregnancy, call 911 or go to the nearest emergency department. This article is educational and does not determine eligibility for any treatment.
Written by the NewDay Wellness editorial team from the sources above and checked against them before publication, and medically reviewed by Dr. Sean Arora and Dr. Shannon Arora of Arora Health & Aesthetics; see our editorial standards. This article is educational and does not diagnose conditions, establish eligibility for any medication, or replace care from a licensed provider. Compounded medications are not FDA-approved.
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