Semaglutide (Ozempic, Wegovy, Rybelsus) and Tirzepatide (Mounjaro, Zepbound) manage type 2 diabetes and weight loss, but what if you’re planning for pregnancy? Both medications belong to the class of GLP-1 receptor agonists, which influence blood sugar regulation, appetite control, and weight loss. They will also make you more fertile, so keep up contraception. However, they are not recommended during pregnancy due to potential risks to fetal development. Stop using GLP-1s two months before becoming pregnant.
Just conquering obesity prior to pregnancy will have long term benefits for your children. Those children born to obese mothers have increased risk of metabolic conditions such as insulin resistance as they age. Too high a blood sugar when you are early pregnant causes birth defects. Everything you do to normalize blood sugar makes pregnancy healthier.
If you’re considering pregnancy while using semaglutide or tirzepatide, here’s what you need to know about safely transitioning off these medications, optimizing fertility, and ensuring a healthy pregnancy.
Why Stop Semaglutide or Tirzepatide Before Pregnancy?
These GLP-1 medicines are very large molecules, and would not be able to cross the placenta into the fetal blood stream. For those taking compounded medication the level of B12 may be higher than recommended in pregnancy as well.
Both semaglutide and tirzepatide have not been studied extensively in pregnant women, but animal studies suggest potential risks to fetal development, including:
- Fetal growth restriction
- Structural abnormalities
- Miscarriage (observed in animal studies at high doses)
- Stillbirth, animal studies show risk at all doses.
As a result, the FDA classifies GLP-1 receptor agonists as Category C, meaning that potential risks to the fetus cannot be ruled out.
When Should You Stop Taking Semaglutide or Tirzepatide Before Pregnancy?
Current guidelines recommend discontinuing semaglutide and tirzepatide at least 2 months before attempting pregnancy due to their long half-lives and prolonged effects in the body.
- Semaglutide has a half-life of about 7 days, meaning it can take several weeks to clear from the system.
- Tirzepatide has an even longer half-life of about 5 days per dose, requiring up to 8 weeks for full clearance.
Since these medications affect metabolism and appetite, stopping them abruptly can lead to weight regain and changes in blood sugar levels, so careful planning is necessary. Increased exercise is helpful for both fertility and having a healthy pregnancy.
How to Transition Off Semaglutide or Tirzepatide Safely Before Pregnancy
- Consult Your Healthcare Provider
- Work with your doctor to gradually taper off the medication, if necessary.
- Discuss alternative diabetes or weight management strategies.
- Metformin is prescribed during pregnancy but safety data is scant.
- Focus on a Nutrient-Dense Diet
- Increase lean protein, fiber, and healthy fats to help regulate hunger and prevent excessive weight gain.
- Consider a Mediterranean-style diet, which has been linked to better fertility outcomes.
- Monitor Blood Sugar Levels (For Those With Diabetes or Insulin Resistance)
- Stopping GLP-1 receptor agonists may lead to increased blood sugar levels.
- Your doctor may adjust medications to maintain glucose control during pregnancy.
- Maintain a Healthy Weight
- If weight loss was a primary reason for taking these medications, continue regular exercise and portion control to sustain a healthy BMI before pregnancy.
- Excessive weight gain post-medication discontinuation can increase the risk of gestational diabetes and complications.
- Supplement with Prenatal Vitamins
- Folic acid (at least 400 mcg daily) is crucial to prevent neural tube defects.
- Vitamin D and omega-3 fatty acids support overall maternal and fetal health.
Fertility Considerations After Stopping GLP-1 Medications
Some women report changes in menstrual cycles and ovulation after stopping semaglutide or tirzepatide. Since these medications impact insulin resistance and hormone regulation, it’s essential to:
- Track ovulation using ovulation predictor kits (OPKs) or basal body temperature.
- Maintain a stable weight, as rapid weight regain can impact fertility.
- Be patient, as it may take a few months for normal cycles to return.
For women with PCOS (polycystic ovary syndrome), stopping GLP-1 medications may cause hormonal fluctuations, so your doctor may recommend alternative treatments like metformin.
What If You Become Pregnant While Still on Semaglutide or Tirzepatide?
If you discover that you’re pregnant while still taking these medications:
- Stop the medication immediately and contact your doctor.
- Schedule an early ultrasound to assess fetal development.
- Monitor blood sugar levels, as discontinuation may cause fluctuations.
Although the risks are theoretical based on animal studies, close monitoring is recommended.
Postpartum and Breastfeeding Considerations
- GLP-1 receptor agonists are not recommended while breastfeeding, as their effects on milk production and the infant are unknown.
- If restarting semaglutide or tirzepatide postpartum, ensure stable milk supply before resuming the medication.
- If weight loss is a postpartum goal, discuss safe timing for restarting with your doctor.
Final Thoughts
Pregnancy planning while on semaglutide or tirzepatide requires careful consideration. Since these medications remain in the body for weeks after stopping, discontinuation should occur at least two months before conception. Managing weight, monitoring blood sugar, and ensuring proper nutrition will help support a healthy pregnancy and baby.
Generally these medicaitons decrease inflammation. Inflammatory conditions like poor gum health leads to poor pregnancy outcomes. Yet, the placenta needs local inflammation to maintain proper implantation. So there is a lot we don’t know.
If you’re thinking about pregnancy and currently taking one of these medications, talk to your doctor early in the process to create a personalized plan that ensures both your health and your baby’s well-being.
Would you like a customized pregnancy preparation plan tailored to your health needs? Let us know how we can help!
