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Consensus guidelines for the use of GLP-1 medications in pregnancy, breastfeeding and postpartum has been published following an international review.
The systematic scoping review and consensus guidelines for clinical practice were published by a multidisciplinary group of experts in Obesity Reviews on 29 July 2026.
The guidance said that incretin-based medication therapy should not be deliberately continued throughout pregnancy.
However, it noted that for those who have inadvertent exposure during pregnancy, reassurance should be provided that current data show no increased risk for congenital anomalies following exposure in early pregnancy.
After birth, the guidance said that incretin-based therapy for women with previous gestational diabetes appears to be effective for weight reduction, as well as the improvement of glycaemic parameter — although, the optimal timing to commence and continue this therapy is unknown and should take into consideration lactation needs.
The use of incretin-based medications during breastfeeding should be assessed on an individual basis, owing to a lack of evidence, it said.
“Women of reproductive age using incretin-based medication should be supported by a multidisciplinary team, including a registered dietitian,” the guidance continued.
“This is particularly relevant for those who are seeking to conceive, during and after pregnancy, and for those who may have other dietary needs.”
Commenting on the consensus guideline, Hannah Beba, consultant pharmacist and clinical lead for obesity at the West Yorkshire Health and Care Partnership, said: “A structured international consensus spanning contraception, preconception, pregnancy, breastfeeding and postpartum is overdue given how many women of reproductive age are now prescribed these drugs.”
In particular, the guidelines “convert[ed] thin evidence into agreed, citable practice statements” and provided valuable explicit research prioritisation, she said.
“It won’t change what we prescribe, but it should change how we counsel. The realistic gain is consistency — a reference point for local pathways and preconception checklists, and for conversations that currently happen unevenly: contraception at initiation and at every dose escalation, washout timing before a planned pregnancy, and what to do when someone conceives unexpectedly.”
Sehar Shahid, a board member for Scotland at the National Pharmacy Association and a pharmacist prescriber working in obesity services, said the consensus “fills a real gap in day-to-day practice”.
“Until now, advice on incretin use around pregnancy has largely been reactive — extrapolated from manufacturer [summary of product characteristics] and general caution rather than any pooled evidence base,” she said.
“Having an international, multi-society consensus gives us something concrete to reference when counselling patients, which matters because these conversations happen far more often than people might assume, given how many women of reproductive age are now prescribed these medicines for obesity.”
Shahid added: “For me, contraception counselling is really what makes the rest of this guidance workable in practice… Anyone starting incretin-based therapy for obesity should be having a proper conversation about effective contraception from day one, not as an afterthought… This should be routine at initiation, not something patients have to raise themselves.”
She also noted the importance of contraception to avoid pregnancy on GLP-1s and the impact of gastrointestinal side effects on oral contraception use.
“The reassurance on inadvertent early-pregnancy exposure is probably the single most useful part of this guidance for frontline prescribing. Despite good contraceptive counselling, unplanned or irregular conception isn’t unusual in this patient group — sometimes because weight loss itself restores fertility faster than patients or clinicians expect,” Shahid said.
“Being able to reassure a worried patient that current data doesn’t show increased risk of congenital anomalies, rather than leaving them in limbo for weeks awaiting specialist review, is a genuine improvement in the quality of care we can offer.”
Both Beba and Shahid concluded that more research was needed in this area.
Amira Guirguis, chief scientist at the Royal College of Pharmacy, said: “This timely guidance provides clinicians with a clearer framework for supporting women before, during and after pregnancy, while being transparent about what we know and what we still do not know. It provides reassurance that the available evidence has not identified an increased risk of major congenital anomalies following inadvertent exposure in early pregnancy.
“This is broadly consistent with current UK advice and should help clinicians provide balanced reassurance to women who become pregnant unexpectedly while taking these medicines.
“At the same time, it reinforces that these medicines should not be continued during pregnancy and highlights important evidence gaps, particularly around breastfeeding, exposure later in pregnancy and longer-term outcomes for mothers and children. While it is unlikely to change UK prescribing practice immediately, it should help clinicians provide more consistent counselling.”
