Pregnancy is a sensitive process, and careful consideration can help ensure optimal health outcomes for mother and child. Certain considerations are well known and obvious to most, including avoiding alcohol or other substances while carrying a fetus or breastfeeding. Others are sometimes overlooked, like how benign and helpful medications for the mother can be downright toxic and dangerous to a fetus. In some cases, the effects of a drug on a fetus may not be well known, in which cases a precautionary approach is often a sound decision.

Ozempic is a popular anti-diabetes medication and weight-loss aid taken by many. It is tolerated reasonably well amongst adults, but is being strongly discouraged for use amongst pregnant or conceiving women. To find out why, read on.

What is Ozempic?

Ozempic is the brand name given to semaglutide, a medication approved for the treatment of type 2 diabetes and chronic weight management in adults. Semaglutide is also sold under various proprietary formulations including Rybelsus and Wegovy, but for the sake of simplicity, we will refer to all semaglutide medications as Ozempic in this article.

In recent months, and largely through social media channels, Ozempic has surged in popularity. This is due in large part to the claims that many influencers and prominent media figures have made regarding its ability to act as a weight loss aid. While initially only FDA-approved for treating type 2 diabetes, it was also given off-label to patients seeking assistance with achieving their weight loss aims. Nevertheless, Ozempic remains a useful tool in the toolkit of many diabetics and their doctors, as part of an overall diabetes management strategy.

Importance of Diabetes Management while Pregnant

Diabetes and pregnancy are two complex medical conditions which become even more complex when they intersect. Consequently, doctors should make diabetes management a priority in pregnant diabetic patients and should monitor non-diabetic patients for the development of gestational diabetes, or new cases of diabetes that develop at some point during a pregnancy.

Pregnancy can wreak havoc on a woman’s blood sugar levels and hormonal regulation in the best of circumstances. Throwing diabetes into the mix (whether it pre-dates the pregnancy or has developed during) can lead to severe complications like pre-eclampsia (which involves dangerously high blood pressure and potential damage to vital organs), ketoacidosis (a life-threatening condition caused by insufficient sugar metabolism and the resulting buildup of ketones in the blood), and birth defects. Doctors must therefore ensure that diabetic patients have a treatment plan in place to diligently monitor and treat symptoms of their diabetes through their pregnancy and until they have returned to a post-partum baseline.

Ozempic is not Recommended during Pregnancy

Despite the importance of vigilantly managing diabetes throughout pregnancy, and despite its efficacy as an anti-diabetic medication, Ozempic is often strongly discouraged throughout all stages of pregnancy in women – as well as for some time before and after. As we will discuss in greater detail in later sections, research has raised important questions about the safety of Ozempic in pregnant women. Thus, in light of the existence of effective alternative anti-diabetic medications, doctors prefer to avoid the unknown risks associated with it, for now.

Adversity of Weight Loss While Pregnant

In addition to the potential for direct harm arising from the drug’s activity in the body, Ozempic-induced weight loss may also pose a risk of harm to the developing fetus. Its characteristic weight-loss-inducing qualities make it a boon for certain patients for whom weight loss is desirable, but the same qualities can make it downright dangerous in the context of pregnancy. This is because the delicate process of gestation requires particular conditions in order to achieve the best outcome.

Among these factors are the body mass of the mother – below certain body mass levels in pregnant women, fetuses can develop abnormalities such as intrauterine growth restriction. This condition likely results from poor fetal nutrition available through the placenta, as the limited nutritional intake of the mother leaves insufficient excess to feed the growth and development of the fetus.

Ozempic and Conception

There is very little evidence available from human trials from which to draw conclusions about the safety of conceiving while taking Ozempic. However, studies have been conducted on animal models to evaluate the effects, if any, of Ozempic on various metrics for success and health in conception. Granted, animal models are imperfect analogues for humans and any results from animal testing should generally be taken with a grain of salt. However, when researchers observe consistently negative outcomes in animal models, it should at least raise a red flag that humans may also encounter similar complications. And, as it turns out, that essentially sums up the outcomes of Ozempic animal trials for conception safety. For example, studies in rat models showed an increase in the prevalence of abnormal fetal development and decreased fetal weight, while rabbit studies observed an increase in early pregnancy miscarriages and structural abnormalities at varying dosages.

From these and other studies, it remains unclear whether a decrease in reproductive success is due to mechanisms impacting conception specifically, or gestation more broadly, however, some researchers have speculated ways in which Ozempic could be detrimental to healthy conception. Ozempic is known to modulate the activity of hormones involved in the metabolism and regulation of glucose, giving it its anti-diabetic qualities. Some researchers have speculated that it may have further impacts on other aspects of the endocrine system, like the Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), which play important roles in the signaling around female menstruation, conception, and gestation.

Given the potential hazards of Ozempic for pregnant women, many doctors will advise sexually active female patients taking it to use some form of contraception concurrent with their treatment. Doing so will minimize the risk of becoming pregnant while taking it, allowing women to be more deliberate about ceasing Ozempic before considering pregnancy (2 – 3 months of discontinuation are often recommended before conception). Speak to your doctor about what modes of contraception might be best for your circumstances, and remember that no form of contraception is 100% protective against pregnancy.

Utility for select fertility patients

While Ozempic is to be avoided immediately before, during, and potentially after pregnancy, some doctors actually prescribe Ozempic to patients intending to conceive. Fertility health is a complex discipline, and there are many factors that contribute to a women’s overall chances of a successful pregnancy. Having a healthy body mass and metabolism can significantly improve outcomes for women looking to conceive. Additionally, patients suffering from polycystic ovarian syndrome (PCOS) may also realize hormonal benefits from Ozempic that can improve fertility.

Thus, many doctors find it appropriate and advisable to prescribe certain patients Ozempic as part of a pre-conception fertility regimen, to bring their weight and metabolic health as close to optimal levels as possible. However, even in these cases, doctors tend to advise that patients discontinue usage at least 2 – 3 months prior to attempting to conceive.

Ozempic and Breastfeeding

We’ve covered the importance of avoiding potential Ozempic-induced risks throughout conception and pregnancy. However, the post-natal context still requires caution.

Ozempic has been approved for the treatment of various conditions in adults, but it remains unclear to what extent the observed safety profiles of the drug are dependent on the age of the user. In other words, though it may be generally tolerated by the adult population, no presumptions can be made that this translates to safe use in minors. Since little data exists on how children might react to the medication, even in subclinical dosages, a precautionary approach would demand that children, particularly newborn infants, avoid exposure to the medication.

Unfortunately, many medications taken by lactating women tend to persist in trace concentrations in the women’s breast milk. At the time of publishing this article, Ozempic’s manufacturer Novo Nordisk advises on their website that it is unknown whether it passes into breast milk in its users, and thus they advise that Ozempic should not be used while breastfeeding given the possibility for breastfeeding infants might be exposed and potentially suffer adverse consequences.

Stopping and Starting

If you take Ozempic or are considering beginning a course of Ozempic (or related medications), your doctor will likely advise you to ensure your usage does not overlap with conception, pregnancy, or breastfeeding. But what if you are currently taking it and intend to become pregnant in the near future? Is it advisable to simply stop your treatment, with the intention of resuming treatment many months down the road?

The answer is yes – and no. Let us explain. On the one hand, yes, you will almost certainly be advised by your doctor to discontinue Ozempic throughout your reproductive episode, and you may indeed plan to resume treatment once your doctor finds it to be in the interests of your (and your child’s) health. Depending on the reason for your Ozempic usage in the first place, your doctor may find that you need not even resume treatment – for instance, if your weight concerns or diabetes management seem to be otherwise under control.

On the other hand, we must stress that prescription medications should be taken as prescribed or otherwise indicated by your doctor and/or pharmacist. It is not typically advisable to abruptly discontinue a course of pharmaceutical treatment (unless medically advised to do so) as doing so can often cause adverse effects. With Ozempic in particular, abrupt discontinuation can cause blood sugar spikes and dysregulation that can be troubling even for non-diabetic patients; for diabetic patients, removing it from a treatment protocol without ensuring other measures are in place to compensate can cause severe symptoms of hypo- and/or hyperglycemia.

For patients looking to discontinue their treatment, a better approach will likely be to either slowly decrease the dosage over a period of time (also known as “tapering”) to allow the body to adjust to the change, and/or explore alternative treatment options to provide comparable therapeutic benefits that don’t carry the same risks. While this sounds significantly more complicated than simply deciding not to take your Ozempic anymore, the good news is that you don’t have to – and actually should not – come up with a discontinuation plan on your own. Instead, consult your doctor about how best to come off the medication and optimize your chances for a healthy pregnancy.