Semaglutide is a medication prescribed to manage blood sugar levels in adults with type 2 diabetes and for chronic weight management. When considering any medication during pregnancy, understanding its potential effects on both the pregnant individual and the developing fetus is a primary concern. This article provides information on semaglutide’s use during pregnancy and breastfeeding, drawing on current scientific knowledge and recommendations.
How Semaglutide Works
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. It works by mimicking the action of a natural hormone, GLP-1, which is released after eating. This hormone plays a role in regulating appetite and blood sugar levels.
Semaglutide binds to and activates GLP-1 receptors, primarily located in the pancreas and brain. This action leads to several effects, including stimulating insulin production in response to elevated blood glucose, reducing the amount of glucagon released by the liver, and slowing down gastric emptying. These combined actions help people feel full longer, eat less, and maintain better control over their blood sugar.
What We Know About Pregnancy Risks
Information regarding semaglutide’s safety during human pregnancy is limited. Much of the understanding comes from animal studies, which have indicated potential risks to the fetus.
Studies in pregnant rats exposed to semaglutide showed increased rates of structural abnormalities, growth issues, and fetal death. Pregnant rabbits and cynomolgus monkeys also experienced miscarriages and their offspring had higher rates of structural abnormalities. These animal findings often coincided with significant weight loss in the pregnant animals, and suggest a potential for harm.
The U.S. Food and Drug Administration (FDA) advises against taking semaglutide during pregnancy. This caution is largely due to the limited human data and the concerning findings from animal studies. Additionally, healthcare professionals generally do not recommend intentional weight loss during pregnancy, as it can be associated with delivering infants who are smaller than average for their gestational age. Ongoing pregnancy registries, such as the one for Wegovy, aim to gather more human data on outcomes in individuals exposed to semaglutide during pregnancy.
Planning Pregnancy and Unexpected Pregnancies
Individuals considering pregnancy while taking semaglutide should consult their healthcare provider. The FDA recommends discontinuing semaglutide at least two months before a planned pregnancy. This recommendation is due to the medication’s long “washout period,” meaning it takes an extended time for the drug to clear from the body. Semaglutide has a half-life of approximately seven days, and it can take up to six weeks for most of the medication to be eliminated from the system.
If an individual becomes pregnant unexpectedly while on semaglutide, immediate consultation with a healthcare provider is advised. The medication should be discontinued, and the patient informed of potential risks to the fetus. Managing underlying conditions like type 2 diabetes during pregnancy is important, as poorly controlled diabetes can lead to complications for both the mother and the fetus, including major birth defects and preterm delivery. Healthcare providers may recommend transitioning to pregnancy-safe alternatives, such as insulin, to manage blood sugar levels effectively. Monitoring the pregnancy closely is also important.
Semaglutide While Breastfeeding
Limited human data exists regarding semaglutide use during breastfeeding. Early research, including a 2024 study on eight breastfeeding women receiving weekly semaglutide injections, indicated that semaglutide was not detected in breast milk samples. This suggests minimal transfer of the injectable form into breast milk, with a calculated relative infant dose (RID) far below the standard 10% safety threshold.
Despite these promising initial findings, semaglutide product labels generally advise against its use while breastfeeding due to limited and evolving data. For the oral tablet form (Rybelsus), no published data exists on its use during breastfeeding, and it is not recommended due to theoretical concerns of higher levels reaching the infant because of an absorption enhancer. While natural GLP-1 is present in breast milk, semaglutide’s potential effects on a nursing infant or milk composition are not fully understood. Therefore, mothers should discuss their individual circumstances and potential risks and benefits with their healthcare provider.