The studies point both ways. A pooled review of three cohorts found an odds ratio of 0.91 (95% CI 0.57 to 1.47) [1]. That is no significant association. A JAMA cohort found hypertensive disorders in 46% of exposed pregnancies against 36% [2]. In that cohort the drug was stopped before or early in pregnancy. A larger records study found the opposite: 19.9% against 22.8% [3].
Preeclampsia is one of several hypertensive disorders of pregnancy. Most studies below count them together. Birth defects and other pregnancy outcomes are a separate question, covered in the pregnancy evidence guide.
1. The pooled review
The review searched five databases to December 2025 [1]. It found three retrospective cohorts, all from the United States. Together they held 10,880 pregnancies: 4,942 exposed and 5,938 unexposed. Exposure meant a GLP-1 before conception or in the first trimester.
Two of the three found lower risk. One found higher. Pooled, the odds ratio was 0.91. The interval runs from a 43% reduction to a 47% increase. The review rules out neither.
2. When the drug was stopped around conception
The JAMA cohort drew on 149,790 pregnancies in one academic health system [2]. Exposure meant a GLP-1 order from three years before conception to 90 days after it. The weight-gain analysis matched 448 exposed pregnancies to 1,344 unexposed. Its population was mainly people with obesity. The obstetric analysis used a separate matched cohort. These are not interchangeable denominators.
Hypertensive disorders reached 46% against 36%, a risk ratio of 1.29 (95% CI 1.12 to 1.49). Weight gain in pregnancy was 13.7 kg against 10.5 kg. Preterm delivery and gestational diabetes were also higher. The authors frame the result as following discontinuation of the drug.
3. When the drug was prescribed in the two prior years
A national records study matched 4,267 pregnancies with a GLP-1 prescription in the prior 24 months against 4,267 with none [3]. Hypertensive disorders ran at 19.9% against 22.8%, an odds ratio of 0.84 (95% CI 0.76 to 0.94). Gestational diabetes and preterm delivery were also lower.
This contrast is different. It compares ever being prescribed with never. It does not separate women who stopped early from women who stopped late.
4. A small cohort pointing up
A fourth cohort studied women with both obesity and diabetes [4]. It found 31 exposed pregnancies and matched 29. Preeclampsia was more common after exposure in the 12 or 24 months before delivery. The abstract reports p-values of 0.023 and 0.018, not rates. Cesarean delivery was also more frequent. With 29 matched pairs, the estimate is fragile.
What the differences mean
The pooled review and individual cohorts are not independent evidence to add together. Exposure windows, patient histories and outcomes differ. Prescription records also do not prove that a medicine was taken.
These results do not establish that earlier treatment prevents preeclampsia or that stopping causes it. Weight regain after stopping is a separate finding, covered in the stopping evidence. It does not prove the mechanism behind these pregnancy associations.
What to do with this
Weight-loss treatment should not continue during pregnancy. Wegovy labeling directs stopping when pregnancy is recognized for weight reduction [5]. For planned pregnancy, its instructions specify stopping at least two months beforehand. This is semaglutide-specific advice, not a class-wide interval. Discuss the exact medicine and a transition plan with your prescriber before trying to conceive. Effects on conception itself are covered in the fertility guide, and the period after birth in the breastfeeding guide.
Tell the obstetric team which medicine you used and when it stopped. Discuss blood pressure, weight and glucose monitoring. If you have diabetes, arrange a pregnancy-appropriate treatment plan rather than leaving high blood sugar untreated.