# GLP-1 Drugs in Pregnancy: What the Evidence Shows, and What It Cannot | This GLP Pooled across 40,000+ exposed pregnancies, congenital malformations were not significantly raised (OR 1.11). Continuing into the first trimester gave a nonlive birth ratio of 1.09. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/glp1-in-pregnancy-what-the-evidence-shows Updated: 2026-10-26 Published: 2026-09-17 [← Research](https://thisglp.com/research) Safety # GLP-1 Drugs in Pregnancy: What the Evidence Shows, and What It Cannot Across 40,000 exposed pregnancies, malformations were not significantly raised. Both sets of authors call their estimates imprecise, and no GLP-1 drug is approved in pregnancy. [This GLP Editorial Team](https://thisglp.com/about)September 20267 min readUpdated September 2026 Every main estimate crosses no-difference · 1.0 · any malformation · major, 1st trimester · major, continuing · nonlive birth · Wide intervals are not the same as reassurance. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - No GLP-1 drug is approved for use in pregnancy, and nothing here is a reason to take one. - Pooled across seven cohorts and more than 40,000 exposed pregnancies, congenital malformations were not significantly raised (OR 1.11, 95% CI 0.82 to 1.51). - A separate study of continuing the drug into the first trimester found nonlive birth at 29.7% against 27.1% (adjusted risk ratio 1.09). - Both sets of authors call their estimates imprecise. Wide intervals that cross one are not evidence of safety. Start with what this is not. These drugs are not approved in pregnancy, and none of the evidence below is a reason to take one while pregnant or trying to conceive. Every study here describes pregnancies that were already exposed, usually before anyone knew about them. The size of that group is set by the contraception question in [what tirzepatide does to oral contraception](https://thisglp.com/research/tirzepatide-and-oral-contraception). Exposure during pregnancy is also distinct from [GLP-1 use before pregnancy and later preeclampsia risk](https://thisglp.com/research/does-a-glp1-before-pregnancy-raise-preeclampsia-risk); timing changes the question being studied. ## What the pooled cohorts found A systematic review and meta-analysis covered seven cohort studies and more than 40,000 exposed pregnancies [\[1\]](https://thisglp.com/research/glp1-in-pregnancy-what-the-evidence-shows#ref-1). Exposure at any point was not associated with congenital malformations overall, at an odds ratio of 1.11 with an interval from 0.82 to 1.51. First-trimester exposure and major malformations came in at 1.39, with an interval from 0.73 to 2.65. Stillbirth, spontaneous abortion, small for gestational age and preterm birth all showed no significant increase. One outcome cleared significance. Urinary malformations came in at 1.24 with an interval from 1.05 to 1.47 — and that estimate rests exclusively on unadjusted data. The authors read it as likely residual confounding rather than a real effect, which is a stronger caveat than most papers attach to their own positive finding. ## What two reviews add A 2026 systematic review read 36 human studies without pooling them [\[3\]](https://thisglp.com/research/glp1-in-pregnancy-what-the-evidence-shows#ref-3). It covered exposure before conception, during pregnancy and after birth. Across large cohorts, early exposure was not consistently tied to major malformations in adjusted analyses. The same held for fetal growth restriction, stillbirth and newborn death. Maternal outcomes were mixed from study to study. Those included gestational diabetes, hypertensive disorders of pregnancy and preterm birth. The authors add that data on continuing the drug through a whole pregnancy remain limited. A 2025 clinical review set out the counseling position [\[4\]](https://thisglp.com/research/glp1-in-pregnancy-what-the-evidence-shows#ref-4). In small animals, exposure in pregnancy was linked to decreased fetal growth, skeletal anomalies and embryonic death. Human case reports and cohorts had not shown a pattern of congenital anomalies. The authors found too little evidence to predict harm, or its absence. They recommend contraception for everyone taking these drugs. ## The question of continuing versus stopping A target trial emulation asked something narrower and more practical: among pregnancies already exposed, what happens if the prescription continues into the first trimester [\[2\]](https://thisglp.com/research/glp1-in-pregnancy-what-the-evidence-shows#ref-2). It used US insurance claims from 2011 to 2024 and covered 3,572 pregnancies, 41.1% of them in women with type 2 diabetes. Continuing a GLP-1 prescription into the first trimester, against not continuing. | Outcome | Continuing vs not | 95% CI | | --- | --- | --- | | Nonlive birth | 29.7% vs 27.1% (aRR 1.09) | 0.98 to 1.23 | | Major congenital malformation | 1.21 | 0.83 to 1.82 | | Small for gestational age | 1.29 | 0.82 to 2.06 | | Large for gestational age | 1.08 | 0.84 to 1.40 | Continuing a GLP-1 prescription into the first trimester, against not continuing. Target trial emulation, 3,572 pregnancies The authors' own words are the finding They conclude that risks were not definitively higher with continuation — and then say the estimates for malformation and small-for-gestational-age were imprecise, and compatible with both no increased risk and clinically relevant differences in risk. That is a study telling you it cannot answer the question, which is different from a study telling you the answer is no. This site keeps that distinction in [the review that found no outcome data at all](https://thisglp.com/research/eight-trials-and-nobody-counted-the-deaths). ## Why confounding is especially hard here People taking these drugs into a pregnancy have higher baseline BMI, more diabetes and more cardiometabolic disease than the general obstetric population. Every one of those independently affects pregnancy outcomes. The target trial emulation names its own version of the problem: potential residual confounding by prior glycemic control. Separating the drug from the reason it was prescribed is the same difficulty this site set out in [what happens when the control group never started treatment](https://thisglp.com/research/do-glp1-drugs-cause-depression). ## What a reader can actually take from this If a pregnancy was exposed before it was known about, the pooled evidence so far does not show an increase in the outcomes that question usually concerns. That is worth knowing and it is genuinely the most common situation. It is a different statement from the drug being safe in pregnancy, which nobody has established and no randomized trial is likely to test. The same "not shown" reading applies in [the Alzheimer's evidence](https://thisglp.com/research/do-glp1-drugs-help-alzheimers). The contraception interaction that puts people in this position is covered in [what tirzepatide does to oral contraception](https://thisglp.com/research/tirzepatide-and-oral-contraception). ## Frequently asked Is it safe to take a GLP-1 drug while pregnant? That is not established. No GLP-1 drug is approved in pregnancy, the pooled certainty of evidence is graded low, and both sets of authors describe their estimates as imprecise. What if I was already taking one when I found out? Across seven cohorts and more than 40,000 exposed pregnancies, congenital malformations were not significantly raised (OR 1.11, 95% CI 0.82 to 1.51), and neither were stillbirth, spontaneous abortion, small for gestational age or preterm birth. Does continuing into the first trimester change anything? In a target trial emulation of 3,572 pregnancies, nonlive birth was 29.7% with continuation against 27.1% without (adjusted risk ratio 1.09). The authors call the malformation and growth estimates imprecise. Should I use contraception while taking a GLP-1? A 2025 clinical review recommends it for everyone taking these drugs, because there is not enough evidence to predict harm, or its absence, after exposure around conception. What about the urinary malformation finding? It reached significance at OR 1.24 but rests entirely on unadjusted estimates, and the authors attribute it to likely residual confounding. ## Sources 1. \[1\] Uysal N, Horoz E, Gungor M, Timarci I, Sozmen MK, Karadas B (2026). Pregnancy outcomes following maternal GLP-1 receptor agonist exposure: a systematic review and meta-analysis Scientific Reports. [PMID 42420519](https://pubmed.ncbi.nlm.nih.gov/42420519/) 2. \[2\] Brown JP, Huybrechts KF, Straub L, Patorno E, Seely EW, Bateman BT (2026). Continuing Glucagon-Like Peptide-1 Receptor Agonists Into the First Trimester of Pregnancy and Pregnancy Outcomes : A Target Trial Emulation Study Using Claims Information Annals of Internal Medicine. [PMID 42258827](https://pubmed.ncbi.nlm.nih.gov/42258827/) 3. \[3\] Ozbek L, et al. (2026). Safety of GLP-1 and Dual GLP-1/GIP Receptor Agonists in Preconception, Pregnancy, and Lactation: A Systematic Review of Maternal, Fetal, and Neonatal Outcomes Diabetes, Obesity and Metabolism. [PMID 41885132](https://pubmed.ncbi.nlm.nih.gov/41885132/) 4. \[4\] Drummond RF, et al. (2025). Glucagon-like peptide-1 receptor agonist use in pregnancy: a review American Journal of Obstetrics and Gynecology. [PMID 39181497](https://pubmed.ncbi.nlm.nih.gov/39181497/) ## More in Safety - [ Medication list · Check combinations · Fluid loss · Changes kidney risk · Pharmacist · Choose a safe option ### Can You Take Ibuprofen With Ozempic? Check Kidney and Stomach Risks ](https://thisglp.com/research/can-you-take-ibuprofen-with-ozempic) - [ 1.9% · Placebo · 8.5% · Ozempic 0.5 mg · 8.8% · Ozempic 1 mg ### Does Ozempic Cause Diarrhea? Rates, Timing, and When to Call ](https://thisglp.com/research/does-ozempic-cause-diarrhea) - [ Sit down · Prevent a fall · Check context · Glucose and fluids · Get help · Severe symptoms ### Does Ozempic Cause Dizziness? What to Check First ](https://thisglp.com/research/does-ozempic-cause-dizziness)