What Happens When Pregnant Women Are Exposed to Semaglutide? First Systematic Review

Across five studies involving 1,128 semaglutide-exposed pregnancies, no clear association with birth defects was identified. One study found a spontaneous abortion rate of 23%, comparable to diabetes and obesity control groups. Another reported an 8.3% prevalence of congenital malformations but no significant risk increase compared to insulin-treated pregnancies. One study linked semaglutide discontinuation to fetal macrosomia and neonatal hypoglycemia. Overall, current evidence does not indicate a consistent increased risk of major congenital malformations from semaglutide exposure.

The researchers conducted a systematic review, searching PubMed, Embase, and ClinicalTrials.gov for studies reporting fetal and neonatal outcomes after semaglutide exposure before or during pregnancy. Two independent reviewers screened and extracted data from the included studies. Due to high variability between studies, results were synthesized narratively rather than combined in a meta-analysis. Bias risk and study quality were formally assessed.

Millions of women of reproductive age now take semaglutide for weight loss or diabetes. Since the drug must be stopped before conception, understanding what happens when pregnancies occur during or shortly after use is critically important. This is the first systematic review to pull together all available evidence on that question.

With GLP-1 drugs becoming some of the most prescribed medications globally, pregnancy safety data is urgently needed. Current labeling requires stopping semaglutide at least two months before conception, and this review suggests that accidental exposure may not carry the catastrophic risks some feared — but much more data is needed before anyone can relax about it.

Only five studies were available, involving heterogeneous designs and populations, which prevented meta-analysis. The studies varied in how they defined exposure timing, outcomes measured, and comparison groups. Risk of bias was a concern across the included research. The small total evidence base means firm conclusions cannot yet be drawn.