The “Ozempic Pregnancy” Trend: An Overview of Current Findings on GLP-1 Receptor Agonists, Weight, Diabetes, and Reproductive Safety

To review current evidence on the reproductive safety, fertility effects, and pregnancy outcomes associated with glucagon-like peptide-1 receptor agonists (GLP-1RAs), with emphasis on semaglutide and liraglutide use in women of reproductive age.

A narrative literature review was conducted using PubMed to identify English-language studies published between 2020 and 2025. Eligible sources included clinical trials, observational cohort studies, registry analyses, systematic reviews, and case reports addressing fertility restoration, inadvertent pregnancy exposure, and fetal outcomes associated with GLP-1RA therapy. Due to heterogeneity in study designs and limited human exposure data, findings were synthesized qualitatively across preclinical, mechanistic, and clinical domains.

Forty peer-reviewed publications were included. Preclinical studies demonstrated dose-dependent fetal growth restriction and skeletal abnormalities, largely attributed to maternal weight loss and nutritional effects rather than direct teratogenicity. Human observational studies and pharmacovigilance registry data did not reveal a consistent increase in major congenital anomalies following early GLP-1RA exposure, although sample sizes were limited and confounding by maternal diabetes and obesity remained substantial. Clinically, GLP-1RAs improved ovulatory function, menstrual regularity, insulin sensitivity, and androgen profiles in women with obesity and polycystic ovary syndrome, frequently restoring fertility within weeks of treatment initiation. Unplanned pregnancies were commonly associated with delayed drug discontinuation, reduced oral contraceptive absorption due to delayed gastric emptying, and insufficient preconception counseling.

GLP-1 receptor agonists offer significant metabolic and reproductive benefits but introduce emerging reproductive-safety challenges due to rapid fertility restoration and increasing inadvertent pregnancy exposure. While available human data are generally reassuring, evidence remains insufficient to definitively establish fetal safety. Proactive preconception counseling, reliable contraception, appropriate washout periods, and expansion of pregnancy registries are essential to guide safe clinical use and inform future evidence-based recommendations.