Preconception GLP-1 Use Not Linked to Higher Pregnancy Risk

Women of reproductive age are increasingly prescribed GLP-1 drugs for weight-management support, but the risks and benefits of using these medications before pregnancy is still poorly understood. Recent research by Cleveland Clinic physicians finds that taking GLP-1 drugs before conception does not increase the risks for adverse pregnancy outcomes and might even provide some protection.

The findings support continuing the use of GLP-1 medications in women with metabolic risk factors who are considering pregnancy, says Cara Dolin, MD, a maternal-fetal medicine specialist, and a coauthor of the research, which was presented at the Society of Maternal-Fetal Medicine pregnancy meeting in February 2026.

“While there’s more research to be done, this data provides some reassurance that it is not harmful to be taking a GLP-1 if you’re planning a pregnancy, and that having done so may in fact benefit you by optimizing your preconception metabolic health,” says Dr. Dolin.

The researchers examined electronic medical records for patients with a pregravid BMI of more than 30 who delivered at more than 20 weeks gestation. Data were reviewed for two studies:

• One to evaluate the association between pre-pregnancy GLP-1 use and the risk of gestational diabetes
• A second to evaluate the risk posed by pre-pregnancy GLP-1 exposure for severe maternal morbidity in patients with obesity

Optimizing metabolic health versus risk of rebound

Women with obesity, diabetes, cardiovascular disease and other cardiometabolic disorders have a higher risk of pregnancy complications including preeclampsia, gestational diabetes, stillbirth, C-section and other outcomes. While GLP-1 medications can help manage these conditions, they are contraindicated during pregnancy, and women are typically advised to stop the medication two months before attempting to conceive.

However, discontinuing the drugs can often lead to rebound weight gain or the worsening of metabolic health. While an attention-getting 2025 study suggested that this rebound worsened some pregnancy outcomes, the risks and benefits are still poorly understood, Dr. Dolin says.

“There is a lot we just don’t know, which is why we wanted to look at our experience here with our Cleveland Clinic patients and see whether taking GLP-1 drugs before pregnancy was causing harm or if it was beneficial and helping patients have healthier pregnancies,” Dr. Dolin says.

Similar outcomes despite higher risk factors

Researchers analyzed data for more than 8,000 women who had obesity but did not have diabetes before they became pregnant. They compared outcomes for 208 women who had been prescribed GLP-1 receptor agonists before pregnancy with those who had not been prescribed the medication.

Women in the GLP-1 group had more risk factors heading into pregnancy. They tended to be older and have a higher body mass index, higher rates of bariatric surgery and chronic hypertension, and present earlier for prenatal care.

However, outcomes for the two groups were similar. Researchers found that the GLP-1 group did not have higher rates of gestational diabetes, severe maternal morbidity, or other adverse maternal outcomes, suggesting that the medication may have helped mitigate elevated risk factors.

“I think this is a really important signal, and it may reflect that these patients were able to optimize their metabolic health prior to conception,” Dr. Dolin says. “It shows there’s potential to use these drugs in a more targeted way with patients who are planning a pregnancy and have these different comorbidities and obesity.”

Consider MFM referral

While the findings suggest that using GLP-1 drugs before pregnancy may be beneficial in women with metabolic risk factors, having a plan to stop the medications before conception is essential, Dr. Dolin notes. In some cases, patients may be transitioned to an alternative medication that is safe for pregnancy and can be used to help manage their metabolic health during pregnancy.

Providers with patients who are taking GLP-1 medications and planning a pregnancy should consider referral to a maternal-fetal medicine specialist for pre-pregnancy counseling.

“We can have a nuanced conversation with the patient about taking the medication, what the benefits are, what the potential risks are, and help them formulate a plan to transition off the medication once they’re ready to start trying to conceive,” she says.