If you are taking a GLP-1 medication—such as semaglutide (Ozempic®, Wegovy®) or tirzepatide (Mounjaro®, Zepbound®)—and thinking about pregnancy, you are not alone in having questions. These medications can improve insulin resistance, support weight loss, and reduce inflammation, all of which may matter for fertility. At the same time, current guidance still recommends stopping them two months before actively trying to conceive.

A new large review offers meaningful reassurance for people who discover they became pregnant while taking a GLP-1 medication. It does not yet support using GLP-1 medications during pregnancy or while trying to conceive, but it is an important step toward better understanding their safety profile.

Why GLP-1s May Matter for Fertility

GLP-1 receptor agonists can be especially relevant for people with insulin resistance, prediabetes, type 2 diabetes, PCOS, or weight-related metabolic concerns. Improving insulin sensitivity may support more regular ovulation and help create a healthier metabolic environment for conception.

There is also growing interest in their potential role beyond blood sugar and weight:

  • Insulin resistance: Better glucose and insulin regulation may support ovulatory function, particularly in PCOS.

  • Weight and metabolic health: Meaningful weight improvement can influence menstrual regularity and fertility potential in some people.

  • Inflammation and endometriosis: While there is no clinical data for the use of endometriosis and GLP-1s, there are mounting reports of patients on GLP-1s with endometriosis showing significant improvement in pain and inflammation. Likely, this is an area to watch and where research is headed.

This creates a real clinical tension: a medication that may improve some factors affecting fertility is also one that current guidelines advise discontinuing before conception.

What the New Study Found

A 2026 systematic review and meta-analysis examined more than 2.1 million pregnancies, including more than 8,000 pregnancies with GLP-1 exposure around conception or in early pregnancy. The researchers looked at whether exposure was associated with miscarriage, stillbirth, congenital anomalies, preterm birth, gestational diabetes, hypertensive disorders of pregnancy, and abnormal fetal growth.

The central finding was cautiously reassuring: the study did not find a clearly detectable increase in these adverse outcomes after periconceptional GLP-1 exposure. In other words, for people who unintentionally became pregnant while taking a GLP-1 medication, the evidence does not show a major safety signal.

That matters because pregnancy is often not recognized until several weeks after conception. Many people will have had exposure before they knew they were pregnant, and this research helps reduce unnecessary fear in that situation.

Why This Is Promising

This study does not answer every question, but it moves the conversation in a helpful direction.

First, it provides a much larger evidence base than earlier studies. With more than two million pregnancies included, researchers were better able to look for patterns across a broad range of maternal and fetal outcomes.

Second, it suggests that GLP-1 exposure around conception may not carry the degree of risk that some people fear. The absence of a clear increase in miscarriage, birth anomalies, stillbirth, or preterm birth is reassuring, particularly given how commonly these medications are now used in reproductive-age adults.

Third, it creates a foundation for future research. If larger, longer-term, and more carefully designed studies continue to show reassuring outcomes, we may eventually have enough evidence to guide more nuanced use of GLP-1 medications in people who are trying to conceive—especially those whose insulin resistance, PCOS, weight, or inflammatory condition is a major barrier to fertility.

We're not there yet, but this is reassuring information. Ideally, emerging data will eventually help us distinguish between people for whom a GLP-1 medication may be a useful part of preconception care and those for whom stopping earlier is the safest approach.

What We Still Do Not Know

It is important not to overstate the findings. This research is reassuring, but it is not proof that GLP-1 medications are safe throughout pregnancy or safe to continue while trying to conceive. This research has not changed current guidelines, which still say to stop 2 months prior to trying to conceive. 

Also, there are gaps in the published paper:

  1. The evidence is observational. 

  2. While 2 million pregnancies were studied, only about 8000 of those had GLP-1 exposure.

  3. The type of medication and its indications vary. 

  4. Fertility-specific benefits remain uncertain - while improving insulin resistance and weight may likely help some people conceive, we still need better studies to determine if GLP-1 medications directly improve fertility outcomes.

Current Guidance Has Not Changed

For now, the practical recommendation remains conservative: if you are planning pregnancy, discuss stopping your GLP-1 medication before you begin trying to conceive.

For semaglutide-based medications—including Ozempic®, and Wegovy®—the product labels recommend discontinuing at least two months before a planned pregnancy because semaglutide remains in the body for an extended period.

If You Become Pregnant While Taking One

If you learn you are pregnant while taking a GLP-1 medication, the new evidence is reassuring for accidental exposure around conception and does not show a clear increase in major adverse pregnancy outcomes.

At the same time, this is not a reason to continue the medication during pregnancy. Contact your prescribing clinician promptly, stop the medication as directed, and ensure you are receiving appropriate prenatal care.

Reference: D’Antonio F, Flacco ME, Manzoli L, Samara A, Khalil A. GLP-1 receptor agonist exposure in the periconceptional period and adverse obstetric outcomes: A systematic review and meta-analysis. Med. 2026;7(10). Published online September 29, 2026.