The growing prescription of semaglutide for weight management among reproductive-age women has created an urgent need to understand pregnancy safety outcomes, as many conceptions occur unexpectedly while on treatment. This systematic review examined outcomes from 1,128 pregnancies exposed to the GLP-1 receptor agonist, revealing a complex safety profile that defies simple categorization.
The analysis encompassed five studies tracking various pregnancy outcomes including spontaneous abortion, congenital malformations, and birth complications. Key findings included spontaneous abortion rates of 23% in one cohort, congenital malformation prevalence of 8.3% in another, and associations between treatment discontinuation and fetal macrosomia. Notably, when compared to control groups with similar metabolic conditions, semaglutide exposure did not demonstrate significantly elevated risks for major adverse outcomes.
This evidence base remains critically limited for definitive clinical guidance. The heterogeneous study designs prevented meta-analysis, and most data comes from observational reports rather than controlled trials. The 8.3% malformation rate, while concerning in isolation, aligns with background rates in diabetic populations, suggesting the underlying metabolic dysfunction rather than semaglutide itself may drive adverse outcomes. The connection between discontinuation and macrosomia particularly highlights the complex interplay between maternal glycemic control and fetal development. While these preliminary findings offer some reassurance, they underscore the need for larger prospective studies and standardized reporting protocols. For now, the risk-benefit calculation for continuing or discontinuing semaglutide during pregnancy remains highly individualized, requiring careful consideration of maternal metabolic health alongside potential fetal exposure risks.