A scoping review of 13 studies found that accidental periconceptional exposure to GLP-1 receptor agonists was not associated with increased risk of major congenital malformations or pregnancy loss, though only minor complications were reported.
0 increased major malformation riskAcross all 13 included studies — 10 case reports and 3 cohort studies — no study found an increased risk of major congenital malformations from periconceptional GLP-1 receptor agonist exposure.
What the researchers found
From 881 screened articles, 13 met inclusion criteria: 10 case reports and 3 cohort studies examining pregnancy outcomes after periconceptional GLP-1 receptor agonist exposure.
Key findings across all included studies:
- No increased risk of major congenital malformations in any study
- No pregnancy losses or elective terminations reported in any study
- Minor complications reported in case reports included: emergency cesarean delivery, preeclampsia, macrosomia (large baby), shoulder dystocia, and transient neonatal hypoglycemia
- These minor complications are common in pregnancies complicated by pre-existing diabetes and obesity
Why it matters
This is one of the most urgent questions in reproductive health right now. The 'Ozempic baby' phenomenon — unexpected pregnancies in women on GLP-1 drugs whose fertility was restored by weight loss — has generated widespread public concern. Women who discover they're pregnant while on these medications need evidence-based guidance about whether to be worried. This review provides early reassurance that accidental exposure does not appear to cause major birth defects, though the evidence remains limited.
How the study worked
The scoping review followed Joanna Briggs Institute methodology. Databases searched included MEDLINE, Embase, Scopus, open-access clinical trial registries, ProQuest Dissertations & Theses Global, and medRxiv, covering January 2005 to March 2025. All evidence levels and report types were included. Articles were screened in duplicate at abstract and full-text levels by two independent reviewers, with disagreements resolved through consensus. Data from 13 eligible articles were charted and summarized narratively.
What this study cannot tell us
The evidence base is extremely limited — only 13 studies, predominantly case reports (10 of 13), which represent the lowest level of clinical evidence. The 3 cohort studies are not sufficient for definitive conclusions. The total number of exposed pregnancies across all studies is very small. Publication bias may favor reporting of adverse outcomes. The review cannot distinguish between effects of the drug and effects of the underlying conditions (diabetes, obesity) that prompted its use. Long-term developmental outcomes of exposed children are not available. Different GLP-1 drugs may carry different risks.
How to read the evidence
This is a scoping review with rigorous methodology (JBI framework, dual screening, comprehensive database search), but the underlying evidence is weak — predominantly case reports with only 3 cohort studies. The total number of exposed pregnancies is small. The review accurately characterizes the current evidence landscape but cannot provide definitive safety conclusions.
When this study was published
Published in 2026 with a search through March 2025, this is the most current synthesis of evidence on GLP-1 drugs and pregnancy outcomes. This topic is evolving rapidly as more exposure data accumulates.
The bigger picture
GLP-1 receptor agonists are among the most prescribed medications globally, and their use is expanding rapidly beyond diabetes into obesity management. As reproductive-age women increasingly take these drugs, accidental periconceptional exposure will become more common. Establishing a safety profile for early pregnancy exposure is critical for clinical guidelines, patient counseling, and informed consent. This review represents the first systematic synthesis of available evidence on this increasingly important question.
Questions still open
- Should women of reproductive age be counseled about contraception when starting GLP-1 receptor agonists, given that weight loss can restore ovulation?
- Are there differences in pregnancy safety between different GLP-1 drugs (semaglutide, liraglutide, tirzepatide)?
- What are the long-term developmental outcomes for children exposed to GLP-1 drugs during the periconceptional period?
Common questions
I got pregnant while taking a GLP-1 drug — should I be worried about birth defects?
Why are more women getting pregnant while on GLP-1 drugs?
Read the original research
Outcomes of Maternal Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Scoping Review of Evidence and Reporting Trends.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 48(1), 103191
Citation
Lee, In Ok; Ghiasi, Maryam; Wong, Karen; Walker, Mark. (2026). Outcomes of Maternal Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Scoping Review of Evidence and Reporting Trends.. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 48(1), 103191. https://doi.org/10.1016/j.jogc.2025.103191