The world’s fastest-growing class of weight-loss medicines has reached a critical crossroads: millions of women of reproductive age are now using glucagon-like peptide-1 (GLP-1) and related incretin-based drugs, yet clinicians still have limited evidence to guide treatment before, during and after pregnancy. An international team of researchers, including a Marshall University physician, has now published the first comprehensive clinical review and consensus guidance focused specifically on these medications and reproductive health.
The review, published in Obesity Reviews, examines how incretin-based therapies may affect fertility, pregnancy, breastfeeding and postpartum health. These drugs include GLP-1 receptor agonists and other medicines that mimic or enhance hormones involved in appetite regulation, insulin secretion and blood-glucose control. By slowing gastric emptying, reducing hunger and improving metabolic regulation, they have transformed the treatment of obesity and type 2 diabetes. Their rapid adoption, however, has moved faster than research into their effects on women who may become pregnant.
Dr. Shahrad Taheri, professor and vice dean for adiposity-based chronic diseases at the Marshall University Joan C. Edwards School of Medicine, was the only U.S.-based contributor to the international project. The collaboration brought together experts from Europe, North America and the Middle East across 23 institutions. Their goal was not simply to summarize existing studies, but to translate fragmented evidence into practical recommendations for clinicians managing women throughout the reproductive lifespan.
The researchers analyzed 34 studies, including randomized clinical trials, observational research, pharmacovigilance reports and individual case studies. This evidence was used to address questions that are becoming increasingly urgent in everyday medical practice: whether incretin-based medications influence fertility, what should happen if a patient becomes pregnant unexpectedly, whether exposure early in pregnancy increases the risk of birth defects, and when treatment might safely resume after delivery.
One of the review’s most important findings is also one of its most cautious. The available evidence did not identify an increased risk of major congenital anomalies after inadvertent exposure during early pregnancy. That finding may offer limited reassurance to patients who discover they are pregnant while taking a GLP-1-based medication. It does not, however, establish that these medicines are safe during pregnancy. The authors stress that the available studies are too small and incomplete to determine their effects on fetal growth, pregnancy complications, neurodevelopment or long-term health in children.
The review also highlights a potentially beneficial role before conception. In women living with obesity or polycystic ovary syndrome—recently referred to in the review as polyendocrine metabolic ovarian syndrome—incretin-based treatment may improve metabolic health and fertility-related outcomes. Obesity and insulin resistance can disrupt ovulation and reproductive hormone signaling, while weight reduction and improved glucose regulation may help restore more regular reproductive function. Yet the authors emphasize that these possible benefits must be balanced against the need to discontinue treatment before pregnancy and the possibility that fertility may return as metabolic health improves.
Because conception can occur unexpectedly, the guidance places particular importance on contraceptive counseling. Clinicians are encouraged to discuss pregnancy intentions before prescribing incretin-based medications and to explain that treatment plans may need to change well before conception. Some drugs also affect gastrointestinal motility, raising questions about the absorption of oral medicines, including certain contraceptives, especially during periods of nausea, vomiting or dose escalation. Individual counseling is therefore essential rather than relying on a single universal rule.
The evidence is even more limited for breastfeeding and the postpartum period. Although some incretin-based medicines may be present at very low or undetectable levels in breast milk, the review states that current data are insufficient to support their routine use while breastfeeding. Researchers do not yet know enough about possible effects on nursing infants, milk production or maternal recovery after delivery. Postpartum decisions must also account for glucose control, weight changes, nutritional demands, mental health, lactation goals and whether the patient has diabetes or other obesity-related conditions.
Taheri said the rapid expansion of GLP-1 therapies has outpaced the evidence needed to protect and guide women planning pregnancy or becoming pregnant. The authors conclude that almost half of the clinically important questions about incretin-based medications and reproductive health remain unanswered. They call for prospective studies, pregnancy registries and long-term follow-up of both mothers and children. Such research could determine whether these medicines have effects that are not visible in short clinical trials or spontaneous safety reports.
The new consensus does not present incretin-based medications as universally dangerous or universally safe. Instead, it offers a framework for shared decision-making while identifying the boundaries of current knowledge. As use of these therapies continues to expand worldwide, the findings provide clinicians with a foundation for contraception planning, preconception care, pregnancy management, breastfeeding decisions and postpartum treatment. They also underline a broader scientific challenge: medical innovation is advancing rapidly, but reproductive safety evidence must catch up before the next generation of therapies becomes even more widely used.
Subject of Research: People
Article Title: Incretin-Based Medications in Women and Reproduction: A Systematic Scoping Review and Consensus Guidelines for Clinical Practice
News Publication Date: 29-Jul-2026
Web References: https://doi.org/10.1111/obr.70203
References: Obesity Reviews, DOI: 10.1111/obr.70203
Keywords: GLP-1 medications, incretin-based therapies, obesity, pregnancy, fertility, breastfeeding, postpartum health, polycystic ovary syndrome, reproductive medicine, metabolic health
