Should You Stop a GLP-1 Before Trying to Get Pregnant? What the Labels and Pregnancy Studies Show

Should you stop a GLP-1 before trying to get pregnant? According to the prescribing information, the answer is yes. The Wegovy label tells people using semaglutide for weight reduction to stop at least 2 months before a planned pregnancy, because semaglutide stays in your body for weeks after the last dose. The Zepbound (tirzepatide) label does not give a fixed washout period, although it says weight loss offers no benefit during pregnancy and that the drug should be stopped as soon as a pregnancy is recognized.

What the labels cannot tell you is what happens to the pregnancy itself. Large observational studies are now answering that question, and the picture is more complicated than a simple verdict of safe or dangerous. The birth defect data so far look broadly reassuring, while the newer worry concerns what happens after the drug is stopped: in a 2025 JAMA study, pregnancies that followed GLP-1 discontinuation had more weight gain, more gestational diabetes and more preterm births. This article walks you through both sets of findings. It is educational content about published research rather than medical advice, and if you are planning a pregnancy while on a GLP-1, the plan is one to make with your prescriber.

The semaglutide and tirzepatide labels both tell you to stop the medicine for pregnancy, but only the semaglutide label sets a washout before conception. Section 8.3 of the Wegovy prescribing information on DailyMed reads: "discontinue WEGOVY in patients at least 2 months before they plan to become pregnant to account for the long half-life of semaglutide." The same label explains the timing in its pharmacology section, where it says that with an elimination half life of about 1 week, semaglutide "will be present in the circulation for about 5 to 7 weeks" after the last 2.4 mg or 7.2 mg injection or 25 mg tablet.

The Zepbound label takes a different approach. Its pregnancy section states that "weight loss offers no benefit to a pregnant patient and may cause fetal harm" and tells prescribers to advise patients to discontinue Zepbound "when a pregnancy is recognized." It lists the tirzepatide half life as approximately 5 days, which is shorter than semaglutide's, and it does not name a specific number of weeks to stop before you try to conceive.

Both labels make the same underlying point, which is that human pregnancy data are not strong enough to rule out risk and that animal reproduction studies raised concerns. The Zepbound label says that in pregnant rats given tirzepatide during organogenesis, "fetal growth reductions and fetal abnormalities occurred at clinical exposure," and the Wegovy label reports embryofetal deaths, structural abnormalities and growth changes in rats at clinically relevant exposures. Animal findings do not prove the same effect in people, which is exactly why the labels lean cautious.

The half life matters because a GLP-1 does not leave your body when you skip a dose. Semaglutide is built to bind albumin, the main protein in blood, which slows its clearance and lets it be dosed once a week. The price of that convenience is a long tail, since according to the Wegovy label semaglutide is still present in the circulation for about 5 to 7 weeks after the last dose. A 2 month stop gives that tail time to clear before conception, so the earliest weeks of pregnancy, when organs form, are not spent with meaningful drug levels on board.

Tirzepatide's shorter half life of about 5 days means it clears faster, which may be part of why its label ties discontinuation to recognizing a pregnancy rather than to a fixed lead time. Neither label is a substitute for an individual plan made with your prescriber. Our explainer on [peptide half life and dosing frequency](https://www.peptidepeppers.com/articles/peptide-half-life-dosing-frequency) covers why some peptides last hours and others last weeks.

Tirzepatide can make birth control pills less reliable, according to its label. The Zepbound label says the drug "may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying," and it advises switching to a method that is not a pill, or adding a barrier method, for 4 weeks after starting and for 4 weeks after each dose escalation. That matters for pregnancy planning because an unplanned conception while you are on a GLP-1 means exposure during the very weeks the labels try to avoid. We cover this interaction in detail in our article on [GLP-1 medications and birth control](https://www.peptidepeppers.com/articles/glp-1-birth-control-contraception-effectiveness).

Current studies have not shown a large increase in birth defects with early pregnancy GLP-1 exposure, but the data come almost entirely from accidental exposures and remain imprecise. No GLP-1 is approved for use in pregnancy, so nobody has run a randomized trial in pregnant women. A 2025 review by Parker and colleagues in Diabetes, Obesity and Metabolism, which went through FDA and EMA regulatory documents, put it plainly: "Evidence in women having planned pregnancies is lacking," and what exists comes from pregnancies that happened inadvertently during drug trials ([doi.org/10.1111/dom.16437](https://doi.org/10.1111/dom.16437)).

The largest study so far, by Cesta and colleagues in JAMA Internal Medicine in 2024, pooled health records from 4 Nordic countries, the US and Israel ([doi.org/10.1001/jamainternmed.2023.6663](https://doi.org/10.1001/jamainternmed.2023.6663)). It followed pregnant women with type 2 diabetes who filled a prescription for a second line diabetes drug at any point from 90 days before pregnancy to the end of the first trimester, and it compared them with women on insulin.

Major congenital malformations were found in 8.3% of 938 infants exposed to GLP-1 receptor agonists and in 7.8% of 5,078 infants exposed to insulin. After adjustment, the relative risk for GLP-1 drugs versus insulin was 0.95, with a confidence interval of 0.72 to 1.26. For context, the malformation rate was 3.7% across all infants and 5.3% among infants born to women with type 2 diabetes, which shows how much of the baseline risk comes from diabetes itself. The authors concluded that the results "did not indicate a large increased risk" above the risk of the underlying diabetes, while adding that "confirmation from other studies is needed."

The key limitation of the Cesta study is its population. These were women with type 2 diabetes rather than women using a GLP-1 for weight loss without diabetes, so the results cannot be transferred directly to you if that second group describes your situation.

A smaller prospective study did include weight management users. Dao and colleagues, writing in BMJ Open in 2024, used the records of six Teratology Information Services in Europe and Israel, which follow pregnancies after a woman or her clinician calls about a medicine exposure ([doi.org/10.1136/bmjopen-2023-083550](https://doi.org/10.1136/bmjopen-2023-083550)). They compared 168 pregnancies exposed to a GLP-1 in the first trimester with 156 pregnancies in women with diabetes on other drugs and 163 pregnancies in women with overweight or obesity.

Major birth defects occurred in 2.6% of the GLP-1 group, 2.3% of the diabetes group and 3.9% of the overweight or obesity group, with no statistically meaningful difference, and pregnancy losses were not increased either. The authors called the result reassuring for inadvertent exposure but noted that "due to the limited sample size, larger studies are required."

The higher termination rate in the GLP-1 group, at 18%, is worth noting. The study did not show that the drug caused it, and anxiety after an unplanned exposure is one plausible reason, but the data cannot settle that question.

The best available comparison suggests that continuing a GLP-1 into the first trimester was not clearly riskier than stopping at conception, but the numbers are too imprecise to call it safe. Brown and colleagues, in Annals of Internal Medicine in 2026, used US insurance claims to emulate a trial in 3,572 pregnancies in which a GLP-1 had been dispensed in the 90 days before the last menstrual period ([doi.org/10.7326/ANNALS-25-04820](https://doi.org/10.7326/ANNALS-25-04820)). They compared women who kept filling prescriptions into the first trimester with women who did not.

None of these differences was definitive. The authors wrote that the malformation and small for gestational age estimates "were compatible with both no increased risk and clinically relevant differences in risk," which means the study could not rule out a real effect in either direction.

Professional guidance leans toward stopping early. The 2025 Endocrine Society and European Society of Endocrinology guideline on preexisting diabetes and pregnancy suggests that people with type 2 diabetes discontinue a GLP-1 receptor agonist "before conception rather than" during the first trimester ([doi.org/10.1210/clinem/dgaf288](https://doi.org/10.1210/clinem/dgaf288)). The guideline rates the certainty of the evidence behind that suggestion as very low, which tells you how thin this area still is.

Stopping a GLP-1 before pregnancy appears to come with its own risk, which is rebound weight gain. The clearest data come from Maya and colleagues, writing in JAMA in 2025, who studied 149,790 pregnancies in one academic health system ([doi.org/10.1001/jama.2025.20951](https://doi.org/10.1001/jama.2025.20951)). They matched 448 pregnancies with a GLP-1 order between 3 years before and 90 days after conception to 1,344 similar unexposed pregnancies. Most of the exposed group, 84%, had obesity, and 23% had preexisting diabetes.

The GLP-1 exposed pregnancies gained an average of 13.7 kg, compared with 10.5 kg in the matched group, a difference of 3.3 kg, and they were also more likely to have several pregnancy complications.

There was no difference in birth length, in large or small for gestational age births, or in cesarean delivery. Because this was an observational study, it shows an association rather than proof that stopping the drug caused the complications, and women prescribed a GLP-1 may differ from matched controls in ways the analysis could not capture.

A Yale study by Pondugula and colleagues in Obstetrics and Gynecology in 2026, covering 243 patients with GLP-1 exposure up to 1 year before pregnancy, found a related signal in weight management users ([doi.org/10.1097/AOG.0000000000005995](https://doi.org/10.1097/AOG.0000000000005995)). They were less likely to gain below recommendations (adjusted odds ratio 0.37), which the authors said "may reflect rebound weight gain after cessation." That study did not find a link with hypertensive disorders, so the two studies agree on weight but not on blood pressure. Our article on [what happens when you stop a GLP-1](https://www.peptidepeppers.com/articles/glp-1-discontinuation-weight-regain) covers the regain research outside pregnancy.

Pooled across studies, the evidence does not show a clear harm from GLP-1 exposure around conception, and it does not show safety either. D'Antonio and colleagues, writing in Med in 2026, pooled 10 observational studies covering 2,118,215 women, 8,325 of whom were exposed to a GLP-1 within 6 months before a positive pregnancy test ([doi.org/10.1016/j.medj.2026.101267](https://doi.org/10.1016/j.medj.2026.101267)). They found no clearly detectable increase in miscarriage, birth defects, preterm birth, gestational diabetes, abnormal fetal growth or excess weight gain, and their conclusion was careful: the findings "do not establish safety because of heterogeneity, residual confounding, and limited datasets."

If you are on a GLP-1 and thinking about pregnancy, the labels give you a clear starting point: the Wegovy label says to stop semaglutide at least 2 months before a planned pregnancy, and the Zepbound label says to stop tirzepatide once a pregnancy is recognized. The birth defect data are broadly reassuring for accidental exposure, though they are still imprecise, and the newest signal concerns the weight gain and pregnancy complications that may follow once the drug is gone.

How to handle that tradeoff, including nutrition and activity planning in the months before conception, is a conversation to have with your prescriber and your obstetric team well before you start trying. If you were exposed during pregnancy, both drug makers run pregnancy exposure registries that are listed on their labels.

Wegovy (semaglutide) injection and tablet prescribing information. DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b

Zepbound (tirzepatide) injection prescribing information. DailyMed, U.S. National Library of Medicine. dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b

Cesta CE, Rotem R, Bateman BT, et al. Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy. JAMA Internal Medicine, 2024. doi.org/10.1001/jamainternmed.2023.6663

Maya J, Pant D, Fu Y, et al. Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA, 2025. doi.org/10.1001/jama.2025.20951

Dao K, Shechtman S, Weber-Schoendorfer C, et al. Use of GLP1 receptor agonists in early pregnancy and reproductive safety: a multicentre, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ Open, 2024. doi.org/10.1136/bmjopen-2023-083550

Brown JP, Huybrechts KF, Straub L, et al. Continuing Glucagon-Like Peptide-1 Receptor Agonists Into the First Trimester of Pregnancy and Pregnancy Outcomes. Annals of Internal Medicine, 2026. doi.org/10.7326/ANNALS-25-04820

Parker CH, Slattery C, Brennan DJ, le Roux CW. Glucagon-like peptide 1 (GLP-1) receptor agonists' use during pregnancy: Safety data from regulatory clinical trials. Diabetes, Obesity and Metabolism, 2025. doi.org/10.1111/dom.16437

Pondugula N, Culhane JF, Lundsberg LS, et al. Gestational Weight Gain and Hypertensive Disorders of Pregnancy With Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure. Obstetrics and Gynecology, 2026. doi.org/10.1097/AOG.0000000000005995

D'Antonio F, et al. GLP-1 receptor agonist exposure in the periconceptional period and adverse obstetric outcomes: A systematic review and meta-analysis. Med, 2026. doi.org/10.1016/j.medj.2026.101267

Wyckoff JA, et al. Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2025. doi.org/10.1210/clinem/dgaf288