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Pregnant on Ozempic, Wegovy, Mounjaro or Zepbound? What the Research Shows

  • Joshua Silva, MD
  • 2 days ago
  • 7 min read


By Joshua Silva, MD | Medical Director, Potere Health MD | Updated September 2026



Accidentally taking Ozempic, Wegovy, Mounjaro, Zepbound, or another GLP-1 medication around conception or during early pregnancy has not been linked to a clear increase in major birth defects, miscarriage, stillbirth, or preterm birth in current human studies. GLP-1 medications are still not recommended for continued use during pregnancy because important safety questions remain unanswered.¹⁻⁵


The key distinction is accidental early exposure versus intentional continued treatment. Most reassuring studies involve women who took a GLP-1 before conception or during early pregnancy and then stopped. Those studies do not prove that continuing treatment throughout pregnancy is safe.³⁻⁵


Semaglutide (Ozempic and Wegovy) is a GLP-1 receptor agonist. Tirzepatide (Mounjaro and Zepbound) acts on both GIP and GLP-1 receptors. For readability, “GLP-1 medications” is sometimes used here as shorthand for both.



GLP-1 pregnancy safety at a glance


Question

What current human evidence suggests

Accidental early exposure

Generally reassuring

Major birth defects

No clear increased risk detected

Miscarriage

No clear increased risk detected

Preeclampsia, gestational diabetes, preterm birth

No clear increased risk detected

Continued treatment throughout pregnancy

No consistent increased signal

Long-term effects on exposed children

Largely unknown




I got pregnant while taking Ozempic, Wegovy, Mounjaro or Zepbound. Will my baby be okay?


Current human evidence is reassuring. Studies have not found a clear increase in major birth defects, miscarriage, stillbirth, abnormal fetal growth, or preterm birth after GLP-1 exposure around conception or during early pregnancy. However, these studies are observational and cannot prove that the risk is zero.¹⁻⁴


Two 2026 meta-analyses evaluated tens of thousands of GLP-1-exposed pregnancies and found no significant increase in major congenital malformations or several other adverse birth outcomes.¹,² A 2026 study specifically examining women who continued GLP-1 prescriptions into the first trimester was also reassuring, although some outcomes remained too uncommon to exclude small differences in risk.³


What this means: taking a GLP-1 before realizing you are pregnant does not mean that your baby has been harmed.



Do GLP-1 medications cause birth defects or miscarriage?


Current human studies have not demonstrated a significant increase in major birth defects or miscarriage after GLP-1 exposure around conception or during early pregnancy.¹⁻⁴ The evidence is reassuring, but “no increased risk detected” is not the same as proving that these medications have zero pregnancy risk.


One 2026 meta-analysis found a relative risk of 1.02 for major congenital malformations, essentially no difference between exposed and comparison pregnancies.² Large observational studies have reached similar conclusions.³,⁴


Animal studies originally raised concerns about fetal abnormalities, growth problems, and pregnancy loss. Those findings remain one reason for caution, but animal studies do not perfectly predict human pregnancy outcomes.



What if I took Ozempic or another GLP-1 before I knew I was pregnant?


Taking a GLP-1 during the first few weeks before realizing you are pregnant is the exposure scenario for which human evidence is most reassuring. Current studies have not identified a clear increase in major birth defects, pregnancy loss, or abnormal fetal growth after inadvertent early exposure.¹⁻⁴


This matters because accidental exposure is likely to become increasingly common as GLP-1 use expands among women of reproductive age.


The available research supports reassurance after accidental early exposure—not deliberate continuation of treatment.



What should I do if I get pregnant while taking a GLP-1?


If you are taking a GLP-1 for weight loss, current guidance recommends discontinuing treatment when pregnancy is recognized and contacting your prescribing clinician and pregnancy care provider. If you use a GLP-1 for diabetes, another treatment may be needed to maintain appropriate blood sugar control.⁵⁻⁷,¹¹,¹²


That diabetes distinction is important. Poorly controlled diabetes itself can increase pregnancy risks. Stopping a medication without a plan for continued glucose management can therefore create a different problem.⁶,⁷


Do not assume the pregnancy has been harmed, but do make a treatment plan with your clinicians.



Why aren't GLP-1 medications recommended during pregnancy if early exposure looks reassuring?


GLP-1 medications are still not recommended during pregnancy because reassuring evidence about accidental early exposure does not prove that continued treatment is safe. Later-pregnancy exposure, drug-specific risks, fetal growth, maternal nutrition, and long-term childhood outcomes remain inadequately studied.⁵⁻⁷


Think of “GLP-1 use during pregnancy” as three different questions:

Exposure

What we know

Before conception

Growing and generally reassuring evidence

Accidental early-pregnancy exposure

Increasingly reassuring

Continued treatment throughout pregnancy

Insufficient evidence


A medication can be “not recommended during pregnancy” without evidence showing that accidental early exposure commonly harms pregnancy. Those are different scientific questions.



Do GLP-1s increase preeclampsia, gestational diabetes or preterm birth?


Current pooled evidence does not show a consistent increase in preeclampsia, pregnancy-related hypertension, gestational diabetes, or preterm birth after GLP-1 exposure around conception. Individual studies differ, however, because GLP-1 users often have obesity, diabetes, insulin resistance, or other conditions that independently affect pregnancy outcomes.⁸,⁹


A 2026 meta-analysis evaluated 186,598 pregnancies, including 47,159 with GLP-1 exposure, and found no significant increase in gestational diabetes, preterm birth, preeclampsia, or hypertensive disorders.⁸


Other studies have found increased gestational weight gain and some adverse outcomes after women stopped GLP-1 therapy.⁹


This leads to an important interpretation:


Drug exposure, a patient's underlying metabolic risk, and the metabolic effects of stopping treatment are three different variables. Observational studies have difficulty completely separating them.


For example, weight regain or worsening insulin resistance after discontinuation could influence pregnancy outcomes without the medication itself having directly harmed the fetus.



How long before pregnancy should I stop Ozempic, Wegovy, Mounjaro or Zepbound?


Semaglutide (Ozempic or Wegovy) should be stopped at least 2 months before a planned pregnancy according to current U.S. prescribing information. U.S. tirzepatide labeling does not give an equivalent preconception washout interval; the 2026 ADA Standards note that Canadian prescribing information recommends at least 1 month.⁶,¹¹,¹²


This is why the common advice to “stop every GLP-1 two months before pregnancy” is too broad.


Women using a GLP-1 for diabetes may also need time to transition to another treatment and establish stable glucose control before conception.⁶,⁷



Can GLP-1 medications increase fertility or affect birth control?


GLP-1 medications are not fertility drugs, but fertility may improve in some women as weight, insulin resistance, and ovulation improve—particularly in women with obesity or PCOS. Tirzepatide can also reduce the effectiveness of oral hormonal contraceptives when treatment is started or the dose is increased.¹⁰,¹²


Research in women with PCOS has found improved menstrual regularity and higher natural pregnancy rates with GLP-1 treatment.¹⁰ This may help explain pregnancies sometimes called “Ozempic babies.”


For tirzepatide (Mounjaro or Zepbound), current prescribing information recommends using a nonoral contraceptive or adding a barrier method for 4 weeks after starting treatment and for 4 weeks after each dose increase.¹²


That birth-control warning should not automatically be generalized to every GLP-1 medication.



The Bottom Line


If you accidentally become pregnant while taking Ozempic, Wegovy, Mounjaro, Zepbound, or another GLP-1 medication, current human evidence is reassuring. Early exposure has not been linked to a clear increase in major birth defects, miscarriage, stillbirth, or several other adverse pregnancy outcomes.¹⁻⁴


But most of those data involve early exposure followed by discontinuation.

We still do not know enough about intentional treatment later in pregnancy, long-term outcomes in exposed children, or whether every GLP-1 medication carries exactly the same risk.⁵


The most useful way to interpret the evidence is:


Accidental early GLP-1 exposure appears increasingly reassuring. Continued GLP-1 treatment throughout pregnancy has not been established as safe.


If pregnancy occurs while you are taking one of these medications, contact your prescribing clinician and pregnancy care provider. If you have diabetes, make sure there is also a plan for continued glucose control.




Disclaimer


This article provides general medical information and does not replace individualized medical advice or prenatal care.



About the Author


Dr. Joshua Silva, MD, is a licensed physician and Medical Director of Potere Health MD. He earned his medical degree from the University of Hawaiʻi John A. Burns School of Medicine and completed residency training in Occupational and Environmental Medicine at the University of Utah, where he also earned a master’s degree in Occupational Health. He later completed a Master of Business Administration with an emphasis in health care administration at Ohio University.


Dr. Silva specializes in evidence-based weight management, including GLP-1 and GIP therapies such as semaglutide and tirzepatide. His work includes counseling patients on medication safety, treatment planning, and reproductive considerations such as pregnancy exposure, preconception discontinuation, fertility, and contraception. He closely follows emerging research on GLP-1 medications and pregnancy to help patients understand what is known, what remains uncertain, and how current evidence should influence clinical decisions. He provides in-person and virtual care for patients in Salt Lake City, St. George, and Cedar City, Utah.



References


  1. Uysal N, Horoz E, Gungor M, et al. Pregnancy outcomes following maternal GLP-1 receptor agonist exposure: a systematic review and meta-analysis. Sci Rep. Published online July 8, 2026. doi:10.1038/s41598-026-61582-8. Article

  2. Liu X, Xiong B, Yang R, Wang H, Liu Y. Periconceptional use of GLP-1 receptor agonists and the risk of major congenital malformations: a systematic review and meta-analysis. Endocr Connect. 2026;15(7). doi:10.1530/EC-26-0280. Article

  3. Brown JP, Huybrechts KF, Straub L, et al. Continuing glucagon-like peptide-1 receptor agonists into the first trimester of pregnancy and pregnancy outcomes: a target trial emulation study using claims information. Ann Intern Med. 2026;179(7):929-937. doi:10.7326/ANNALS-25-04820. Article

  4. Cesta CE, Rotem R, Bateman BT, et al. Safety of GLP-1 receptor agonists and other second-line antidiabetics in early pregnancy. JAMA Intern Med. 2024;184(2):144-152. doi:10.1001/jamainternmed.2023.6663. Article

  5. Maslin K, Shawe J, Blowers S, et al. Incretin-based medications in women and reproduction: a systematic scoping review and consensus guidelines for clinical practice. Obes Rev. Published online July 29, 2026. doi:10.1111/obr.70203. Article

  6. American Diabetes Association Professional Practice Committee for Diabetes. 15. Management of diabetes in pregnancy: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1). doi:10.2337/dc26-S015. Guideline

  7. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al. Preexisting diabetes and pregnancy: an Endocrine Society and European Society of Endocrinology joint clinical practice guideline. J Clin Endocrinol Metab.2025;110(9):2405-2452. doi:10.1210/clinem/dgaf288. Guideline

  8. Hattler E, Schluter H, Greene C, et al. Glucagon-like peptide-1 receptor agonists and risk of adverse maternal pregnancy outcomes: a systematic review and meta-analysis. Obstet Gynecol. Published online July 2, 2026. doi:10.1097/AOG.0000000000006363. Article

  9. Maya J, Pant D, Fu Y, et al. Gestational weight gain and pregnancy outcomes after GLP-1 receptor agonist discontinuation. JAMA. 2025;334(24):2186-2196. doi:10.1001/jama.2025.20951. Article

  10. Zhou L, Qu H, Yang L, et al. Effects of GLP1RAs on pregnancy rate and menstrual cyclicity in women with polycystic ovary syndrome: a meta-analysis and systematic review. BMC Endocr Disord. 2023;23:245. doi:10.1186/s12902-023-01500-5. Article

  11. Novo Nordisk Inc. Wegovy (semaglutide) prescribing information. DailyMed. Accessed September 2, 2026. Current prescribing information

  12. Eli Lilly and Company. Zepbound (tirzepatide) prescribing information. DailyMed. Accessed September 2, 2026. Current prescribing information

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