EASD 2026: No birth-defect signal with GLP-1s in early pregnancy, but gaps remain

Clinical takeaway: Ask patients with diabetes who take GLP-1–based medications about pregnancy plans. Arrange contraception during treatment, follow product-specific guidance for stopping before a planned pregnancy, and plan how to maintain glucose control afterward. If exposure occurs before pregnancy is recognized, stop treatment and discuss the cautiously reassuring birth-defect data.

As GLP-1–based medications become more common among people of reproductive age, clinicians need to address their use before conception. A review and international expert consensus statement published in The Lancet Obstetrics, Gynaecology & Women’s Health and presented at the 2026 European Association for the Study of Diabetes meeting in Milan offer guidance for women with diabetes.

The clearest finding offers some reassurance when a patient becomes pregnant while taking a GLP-1 medication. Across four studies involving more than 42,000 exposed women, birth-defect rates were similar whether or not women had used a GLP-1 drug. Exposure generally ended in the first trimester, and most of the women studied had type 2 diabetes.

An analysis found early pregnancy loss was 31% more common among exposed women, but its largest contributing study combined miscarriage with elective termination. The result therefore cannot establish whether miscarriage risk increased.

Evidence on continued GLP-1 use in the second and third trimesters came largely from individual case reports, so the review cannot establish its safety later in pregnancy. Two small studies found little or no detectable semaglutide or tirzepatide in breast milk, but they did not establish safety for breastfed infants. The expert panel concluded that evidence is insufficient to support GLP-1 use during breastfeeding.

Before conception, GLP-1 therapy may help women with type 2 diabetes improve glucose levels and weight, the panel said. It recommended contraception during treatment, discontinuation before a planned pregnancy, and a plan to prevent rebound hyperglycemia and weight gain. The authors cautioned that their recommendations should be interpreted “in the context of limited direct evidence,” particularly for women with type 1 diabetes or previous gestational diabetes.

“Millions of women are now using GLP-1 receptor agonists, but there remain important unanswered questions about their impact on fertility, pregnancy, and maternal and child health. Women deserve clearer evidence to guide some of the most important healthcare decisions of their lives. As new weight loss medications enter clinical practice at pace, generating robust evidence for women before, during, and after pregnancy has never been more urgent,” said coauthor Claire Meek, PhD, of the Leicester Diabetes Research Centre, in the conference press release.

Source: Dib S, et al. (2026 Sep 29) The Lancet Obstetrics, Gynaecology & Women’s Health. Preconception, pregnancy, and postnatal use of GLP-1 receptor agonist-based therapies in women with type 1, type 2, or gestational diabetes: a systematic review, meta-analysis, and international expert consensus statement