A review of 1,128 semaglutide-exposed pregnancies found no consistent increased risk of major birth defects, but the evidence is still too limited for firm conclusions.
1,128 pregnanciesAcross five studies, no consistent increased risk of major congenital malformations was found with semaglutide exposure
What the researchers found
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.
Why it matters
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.
How the study worked
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.
Who was studied
1,128 pregnancies with semaglutide exposure during pregnancy or within two months before conception
What this study cannot tell us
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.
How to read the evidence
As a systematic review, this represents high-level evidence synthesis. However, the underlying studies are few in number, heterogeneous in design, and carry risk of bias, which limits the strength of conclusions that can be drawn.
When this study was published
Published in 2026, this is among the most current evidence available on semaglutide and pregnancy outcomes. However, the field is rapidly evolving as larger pregnancy registries report results.
The bigger picture
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.
Questions still open
- What is the critical window of semaglutide exposure during pregnancy — does timing of exposure matter for specific outcomes?
- Are the complications seen (macrosomia, neonatal hypoglycemia) caused by semaglutide itself or by the metabolic rebound after stopping it?
- Will larger prospective registries now tracking semaglutide pregnancies change the risk picture?
Common questions
Does semaglutide cause birth defects?
How long before getting pregnant should you stop semaglutide?
Read the original research
Impact of semaglutide exposure on fetal and neonatal outcomes in pregnant women: a systematic review.
European journal of obstetrics, gynecology, and reproductive biology, 317, 114836
Citation
Mandal, Laura; Andersen, Louise Udby; Luef, Birgitte Møller; Tanvig, Mette Honnens; Vinter, Christina Anne. (2026). Impact of semaglutide exposure on fetal and neonatal outcomes in pregnant women: a systematic review.. European journal of obstetrics, gynecology, and reproductive biology, 317, 114836. https://doi.org/10.1016/j.ejogrb.2025.114836