Are Weight Loss Medications Like Ozempic Safe During Pregnancy?

• There is currently limited study on the effects of weight loss medicines such as Ozempic and Wegovy on Pregnancy/fertility.
• Health professionals advise people who are considering becoming pregnant to stop using such medications at least two months before attempting to conceive.
• Before discontinuing any medications, experts recommend consulting with the healthcare physician who provided them to you.

Maintaining a healthy weight can help while attempting to conceive.

“All the organs that are responsible for producing the hormones necessary for your body to grow an egg, ovulate the egg, and then actually get a period, these things can be disrupted by both extremes of weight,” Dr. Alex Robles, a fertility expert at Columbia University Fertility Center, said.

When people are underweight, their bodies may stop manufacturing estrogen, which can lead to ovulation and irregular periods. To be fertilized by sperm, an egg must undergo ovulation.

“The body has a stress mechanism so it can shut off anything that is not essential and unfortunately the body sees fertility as not essential at times of high stress and starvation,” according to Robles.

Obese or overweight people may also have altered hormone levels as a result of their increased body fat levels, preventing them from ovulation.

“There is a lot of data that points to an association between obesity and infertility, particularly if there is an ovulation disorder,” Robles told reporters.

However, even a minor amount of weight loss can restore hormones required for ovulation and lower the chance of miscarriage and other pregnancy-related issues, he stated.

According to the American College of Obstetricians and Gynecologists, obesity during pregnancy increases the risk of the following:

• Gestational diabetes refers to high blood sugar levels throughout pregnancy, which can raise the chance of delivering a big baby and a cesarean birth.
• Gestational hypertension is high blood pressure that develops in the second half of pregnancy.
  Preeclampsia, pregnant hypertension, which can lead to renal and liver failure, and fetal growth issues.
• Obstructive sleep apnea during pregnancy can induce exhaustion and raise the risk of high blood pressure, preeclampsia, and heart and lung problems.

Also read: Sperm Quality Declines Significantly After Age 50

The popularity of Ozempic and how it relates to fertility

Robles sees an increase in patients taking glucagon-like peptide-1 (GLP-1) receptor agonist drugs such as Ozempic and Wegovy.

“I’ve seen a handful of patients on these medications already and they are not on them for fertility, but for weight regulation and some of them have metabolic abnormalities as in poor blood sugar control, so they’re on them for that reason as well,” he told me.

GLP-1 agonists are FDA-approved for type 2 diabetes, while Wegovy is FDA-approved for weight control.

There is currently limited study on the effects of weight loss medicines such as Ozempic and Wegovy on fertility. As a result, Robles advised anyone who are thinking about getting pregnant to stop taking the medicine for at least a few months before pregnancy.

Dr. Sethu Reddy, the president of the American Association of Clinical Endocrinology, agreed. He stated that none of the GLP-1 receptor agonists are intended to improve fertility, and that if a person conceives while taking a GLP-1 receptor agonist, they should discontinue the medicine.

“There is not a lot of research evidence to support the ongoing use of these medicines throughout pregnancy. They are classified as Category C for usage in pregnancy, which means that ‘risk cannot be ruled out,'” Reddy told Us.

The decision to stop taking Ozempic for fertility/Pregnancy isn’t always easy

Robles noted that people who come to him for a fertility evaluation often want to get pregnant as soon as feasible. However, he emphasized the need of taking time to discontinue medications that may be dangerous to continue taking during the fertility process.

“There is going to be a delay because there is work up involved, where we need to do a lot of testing and determine what is the best treatment options for the patient, so around that time is a good time to inform the patient that it’s a good idea to discontinue soon as they try to conceive in the next couple of months or so,” he told me.

However, stopping medicine to conceive is not always an easy decision. While doctors know which medications are safe to continue during pregnancy, such as asthmatic inhalers, and which are not, such as lithium used to treat bipolar illness, Robles said certain medications are in the gray area.

“[For these medications], animal studies show [one thing], but we don’t see it in human studies yet, and the answer is really we don’t know and in that case, speak to your provider and try to weigh the risks and benefits of staying on a medication versus discontinuing it,” he told me.

If the patient requires medication to maintain their health, such as blood pressure or blood sugar, the provider and patient may decide that it is healthier to continue taking it for the patient’s sake and accept the risks associated with the pregnancy, or they may decide to discontinue.

“It’s very difficult for all parties involved,” Robles said. “As a fertility provider, we’re taking care of a patient from a very unique angle, and from a very specific angle and the nice thing is we will often collaborate with a lot of the patients’ other providers to try to get a multi-disciplinary approach to get the patient their own individualized care.”

Reddy emphasized that consumers should talk to their endocrinologist or primary care physician about initiating or quitting GLP-1 therapy before becoming pregnant.

Robles agreed. The doctor who recommended the medicine is the ideal person to consult, especially if it was prescribed to treat insulin resistance or blood sugar control.

“That particular endocrinologist or primary care physician is going to be the best person to help the patient ween off the medication,” Robles told me. “From the fertility standpoint, we can provide guidance to where the patient is in their treatment plan and when we think the patient will be ready to try to conceive by to help with the timing of the discontinuation.”

Best methods for weight loss during fertility treatment

While weight loss may help improve fertility in persons who are obese or overweight, or who have polycystic ovarian syndrome, Reddy stated that weight loss could occur as a result of lifestyle improvements.

However, when Robles sees a patient who is having trouble conceiving, he says their age influences whether or not weight loss is the first step.

“The reason I say young enough is that many individuals seeking reproductive treatment do not have a lot of time. “These are patients who are in their late 30s or early 40s, and we know that the reproductive window is rapidly closing,” he said.

Weight loss can take several months when done properly, therefore there may not be enough time to affect fertility potential.

If a patient is in their late 20s or early 30s, Robles believes a weight loss trial is feasible to try to restore hormone levels required for pregnancy.

If a patient is in their late 20s or early 30s, Robles believes a weight loss trial is feasible to try to restore hormone levels required for pregnancy.

In this instance, when time permits, he recommends dietary adjustments as the most effective approach to lose weight.

“Based off of the literature, there is pretty clear and consistent data that dietary intervention is going to be the most effective form of weight loss,” he told me.

While many people turn to exercise to reduce weight, he points out that, while exercise is important, it is not as successful as nutrition in weight loss.

Robles advised that persons who lost weight on medications like Ozempic and then stopped taking them when they tried to get pregnancy may regain the weight because the prescription is required to maintain weight loss.

He suggested consulting with your doctor about implementing a nutrition plan and exercise program while taking the medicine so that you can rely on healthy lifestyle choices when you stop using it.

“Ozempic is not a magic bullet. Patients who cease it frequently revert to their original weight, so understanding this and using tried-and-true techniques of lifestyle modification” he said.