Are weight loss drugs safe when trying to get pregnant? Many individuals, especially those managing their weight, ask this question. Weight loss medications like Wegovy have become popular, but what are the risks when it comes to fertility and pregnancy?
Who Benefits from Semaglutide During Pregnancy?
The decision to continue Semaglutide (Wegovy) during pregnancy should be made with a physician. For some patients, the benefits outweigh the risks, especially those with poor glucose control despite insulin use. In healthy individuals, insulin may be sufficient for glucose regulation, and weight loss drugs might be unnecessary. It’s crucial to focus on the long-term health of the child rather than perfect glucose control or weight management without clinical trial data confirming safety.
Weight Gain and Pregnancy
Weight loss is not advisable during pregnancy. Even for obese individuals, a weight gain of 11-20 pounds is recommended. This gain supports the caloric surplus needed for the baby’s development. A caloric deficit can lead to a catabolic state, increasing the risk of miscarriage and disrupting essential biochemical processes for the baby’s growth.
FDA Recommendations and Animal Studies
The FDA advises stopping Semaglutide two months before planning pregnancy as a precaution. Animal studies indicated a possible increase in birth defects and miscarriage rates at higher dosages than those used in humans, where significant weight loss was observed. These findings are not conclusive for humans, and more research is expected by 2027 to clarify the safety of Semaglutide during pregnancy.
Managing Excessive Weight Gain and Sugar Control
Semaglutide may be beneficial for pregnant patients with poorly controlled glucose levels and excessive weight gain despite insulin use. An ideal candidate for continuing Semaglutide through pregnancy has a pre-pregnancy BMI indicating excessive weight gain and a glycated hemoglobin A1C over 7%. Increasing insulin may not be effective for those with high glucose and body mass, as it could lead to further weight gain.
Wegovy and Fertility
Wegovy can affect fertility, potentially beneficially or harmfully, depending on pre-conception body weight and glycemic control. For individuals with normal body weight and glucose levels, Wegovy might increase risks due to a net catabolic state. However, it can improve fertility in women with weight-related issues, such as PCOS, by optimizing weight and glycemic control before conception.
Breastfeeding and Semaglutide
Despite FDA warnings, breastfeeding while taking Semaglutide is likely safe. The drug’s presence in breast milk is minimal, posing little risk to the infant. Ethical concerns prevent definitive studies, but pharmacological knowledge supports the safety of low-dose exposure through breast milk.
Conclusion
While weight loss drugs like Semaglutide should generally be avoided for weight loss during pregnancy, they may be beneficial for patients with uncontrolled glucose and excessive weight gain. It’s essential to consult with healthcare providers to weigh the potential benefits and risks. Breastfeeding on Semaglutide appears safe, despite FDA warnings, due to the negligible drug transfer into breast milk. Always prioritize the long-term health of the child when considering these medications during pregnancy and breastfeeding.
