🤰 ACOG’s New GLP-1 Guidance for Pregnancy and Breastfeeding, Explained
The nation’s ob-gyns have new guidance on one of the most-asked questions in GLP-1 land: what about pregnancy? 💜 On Oct. 23, the American College of Obstetricians and Gynecologists (ACOG) released a practice advisory for clinicians who counsel patients on GLP-1 medicines before, during and after pregnancy.
📰 What Happened
The advisory, “Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation,” was developed with lead author Dr. D. Yvette LaCoursiere, a professor of ob-gyn at UC San Diego. Its recommendations for clinicians cover three stages.
Before pregnancy: ACOG advises ob-gyns and other clinicians to tell patients that there isn’t enough safety data on GLP-1 use in pregnancy, and to recommend that patients consider stopping one to two months before conception. Clinicians are also encouraged to support lifestyle changes and keep an eye on weight after a patient stops.
During pregnancy: ACOG advises clinicians to recommend against GLP-1 use, except within a clinical trial.
While breastfeeding: Clinicians may use shared decision-making with patients to build a postpartum care plan that could include a GLP-1. If one is used, ACOG recommends closely watching the baby’s weight gain together with the infant’s own clinician. It recommends against use when the baby is preterm or a newborn, which ACOG’s announcement defines as within the first 28 days of life.
ACOG also notes that weight loss on these medicines may increase fertility, so it encourages ob-gyns to talk about reliable contraception with patients who don’t want to become pregnant.
🔙 The Backstory
Why now? Dr. LaCoursiere said that as many as “1 in 300 women” are exposed to GLP-1s before pregnancy, and that the medicines are now easy to get through online providers and medical spas. The advisory cites a large study that found GLP-1 prescribing around pregnancy rose more than thirtyfold between 2019 and 2024.
Timing matters because most GLP-1s have long half-lives. That means the body can take days or even weeks to clear them after the last dose. The advisory includes a table of each medication’s half-life.
The evidence so far is thin and mixed. 🔍 In animal studies, GLP-1 use during pregnancy was linked to lower fetal weight and other problems. Human data haven’t shown a consistent rise in birth defects, but ACOG says the studies are few and observational. Some research links using GLP-1s before pregnancy to better outcomes, while other large studies found more weight gain during pregnancy and higher risks of some complications.
ACOG also flags the other side of the coin. Dr. Amy Valent, chair of ACOG’s Clinical Consensus Committee for obstetrics, noted that regaining weight after stopping is common and may itself raise risks.
For breastfeeding, early data suggest GLP-1s are unlikely to pass into breast milk, and a small study didn’t detect semaglutide in milk. Still, no one yet knows how these medicines affect milk supply or composition.
🔮 What’s Next
ACOG says it will update the advisory as research evolves. It calls for larger studies and registries that track mothers’ and babies’ outcomes, milk composition, infant growth and long-term safety. In a perspective published by Healio, Dr. Fatima Cody Stanford said the guidance encourages clinicians to talk about GLP-1s in the context of a patient’s reproductive plans before prescribing them.
🩺 Your Care Team Knows Best
This guidance is written for clinicians, and every pregnancy is different. If you have questions about family planning, pregnancy or breastfeeding, your ob-gyn, doctor or pharmacist is the right person to ask.
💬 Come Chat With the Flock
What questions does this new guidance raise for you? Join the conversation in the Tideflock community forum. 🐦
📚 Sources
ACOG: ACOG releases new guidance on the use of GLP-1s in pregnancy and lactation (Oct. 23, 2026)
Healio: ACOG issues “long-awaited” guidance on GLP-1s during pregnancy, lactation (Oct. 23, 2026)