As GLP-1 receptor agonists and other incretin-based therapies rapidly expand into mainstream obesity and diabetes care, a critical gap has remained largely unaddressed: what happens when these drugs intersect with conception, pregnancy, and breastfeeding? Millions of reproductive-age women are now using semaglutide, tirzepatide, and related agents, making evidence-based reproductive guidance an urgent clinical priority.
An international multidisciplinary panel conducted a systematic scoping review — the most comprehensive to date on this topic — synthesizing 34 studies including 11 randomized trials, 9 observational studies, 2 pharmacovigilance reviews, 9 case reports or series, 2 animal studies, and 1 ex vivo study. The search, completed in July 2025, covered preconception, pregnancy, and postnatal exposure windows using a lifecourse framework. Evidence was found for only 18 of 32 pre-specified research questions (56.3%), with most studies focused on preconception or pregnancy; just two addressed contraception and one examined lactation. The exposed pregnancy sample sizes were notably small across included studies, underscoring the scarcity of high-quality human data.
This review arrives at a pivotal moment. Incretin-based therapies are formally contraindicated in pregnancy due to unknown teratogenicity risk, yet unintended exposures are occurring at scale given the drugs' widespread prescription in women of reproductive age. The evidence base is strikingly thin relative to the clinical urgency — a concern the authors address through expert consensus guidelines intended to bridge the gap until robust longitudinal data exist. The lifecourse framing is analytically valuable, capturing distinct risk-benefit profiles at each reproductive stage rather than treating pregnancy as a single homogeneous event. Key limitations include heavy reliance on case reports, absence of qualitative patient experience data, and very small cohort sizes for exposed pregnancies. This is a confirmatory — and importantly, codifying — contribution: it does not resolve uncertainty but offers structured clinical guidance where none previously existed, making it a meaningful reference point for practitioners managing reproductive-age women on incretin therapies.