GLP-1s and pregnancy: New ACOG guidance urges caution before conception and during breastfeeding

Clinical takeaway: Counsel patients taking GLP-1 receptor agonists to consider discontinuation 1–2 months before conception and avoid use during pregnancy. During lactation, consider treatment through shared decision-making, but recommend against use when breastfeeding preterm infants or infants within the first 28 days of life.

ACOG’s new October 2026 practice advisory addresses growing exposure to GLP-1 therapies among patients of reproductive age. Its central message: Limited human data offer some reassurance after inadvertent early exposure but do not establish safety during pregnancy.

Before conception, discuss effective contraception with patients who do not want to become pregnant, because GLP-1–associated weight loss may improve fertility. The advisory recommends considering discontinuation 1–2 months before conception, recognizing that many agents have long half-lives and may remain in the body for weeks.

If pregnancy occurs during treatment, advise against continued use. Available human studies have not demonstrated a consistent increase in major congenital malformations, but animal studies have reported reduced fetal weight, growth restriction, and abnormal bone development.

Evidence on pregnancy outcomes after prepregnancy use is mixed: Some observational studies suggest benefits, whereas others report greater gestational weight gain and higher risks of gestational diabetes and hypertensive disorders. Confounding and possible rebound effects after discontinuation complicate interpretation.

Stopping treatment also requires a plan, because weight regain is common and may increase pregnancy risks. Monitor weight before, during, and after pregnancy, and support healthy eating, physical activity, dietitian referral, and behavioral interventions as needed.

Evaluate potential nutrient deficiencies, including vitamin D, vitamin B12, and iron stores, particularly when intake has been restricted. ACOG also advises assessing preeclampsia risk and initiating low-dose aspirin when otherwise indicated.

During lactation, clinicians may develop a postpartum plan that includes GLP-1 therapy after discussing uncertainties with the patient. A small study found no detectable subcutaneous semaglutide in human milk, but evidence remains insufficient regarding milk supply, composition, infant growth, and long-term outcomes.

If treatment is chosen, favor shorter-half-life agents; the advisory identifies exenatide as preferred when indicated on this basis. Avoid oral GLP-1 formulations during breastfeeding because safety data are lacking, and coordinate close monitoring of infant weight gain with the infant’s clinician.

“This is a fast-moving area of research, so for now we need to proceed with caution and reassess as more data becomes available,” said lead author D. Yvette LaCoursiere, MD, FACOG, in ACOG’s accompanying announcement.

Key Recommendations

• Counsel about limited pregnancy safety data and consider stopping GLP-1 therapy 1–2 months before conception.
• Discuss effective contraception when pregnancy is not desired; advise against GLP-1 use during pregnancy.
• Anticipate weight regain after discontinuation and provide weight surveillance, nutrition assessment, and lifestyle support.
• Use shared decision-making for lactation; recommend against treatment when breastfeeding preterm infants or infants younger than 28 days.
• If used during lactation, favor shorter-half-life agents, avoid oral formulations, and closely monitor infant weight gain.

Source: American College of Obstetricians and Gynecologists. (2026 Oct) ACOG Practice Advisory. Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation