Stopping GLP-1 Drugs Before Pregnancy Tied to Higher Weight Gain, Complications

Women taking GLP-1 medications for weight loss or diabetes management face a difficult choice when planning pregnancy. Current medical guidance recommends stopping these drugs before conception because the effects on a developing fetus remain unknown. But new research from Mass General Brigham suggests that stopping carries its own set of risks—ones that may be substantial enough to reshape how doctors and patients think about the decision.

Researchers at the Boston health system examined nearly 1,800 pregnancies documented in their records between 2016 and 2025, most involving women with obesity. They compared outcomes for women who had filled a GLP-1 prescription within three years before conception or up to 90 days after it against women who had never used the drugs during that window. The differences were striking. Women who had discontinued GLP-1 medications before pregnancy gained an average of 7.2 pounds more during gestation than those who had never taken them. Beyond the scale, 32 percent more of the GLP-1 discontinuation group gained what clinicians consider an unhealthy amount of weight while pregnant.

The complications extended beyond weight. Women who stopped GLP-1 drugs faced a 30 percent higher risk of developing gestational diabetes—a temporary but serious form of the disease that emerges during pregnancy. Their risk of high blood pressure during pregnancy climbed 29 percent higher. Most concerning, they had a 34 percent elevated risk of delivering before term. The study found no meaningful difference in rates of low or high birth weight babies or in the need for cesarean delivery between the two groups.

Dr. Camille Powe, an endocrinologist at Mass General Brigham and senior author of the study published November 24 in JAMA Network Open, acknowledged the bind this creates. "We need to do more research to find ways to help manage weight gain and reduce risks during pregnancy when stopping GLP-1 medications," she said. The uncertainty cuts both ways: fetal safety concerns remain genuine enough that current medical guidance still recommends discontinuation, yet the data now suggests that stopping may introduce its own hazards.

Dr. Jacqueline Maya, the study's lead author and a pediatric endocrinologist, noted that GLP-1 use among women has grown dramatically in recent years, making this question increasingly urgent. The research team was careful to note that their study was retrospective—it could identify associations between stopping the drugs and worse pregnancy outcomes, but could not definitively prove that discontinuation caused the complications. Still, the findings suggest that women with obesity who are considering pregnancy may face a genuine medical dilemma with no perfect answer.

The path forward likely requires more targeted investigation. Researchers need to better understand both the actual risks these medications pose to a developing fetus and whether there are ways to manage weight and metabolic health during pregnancy for women who must stop taking them. Until then, the decision to start, continue, or stop GLP-1 therapy before conception remains one where the risks of action and inaction both demand serious consideration.