Every FDA-approved GLP-1 and GIP/GLP-1 label tells prescribers to stop the drug before a planned pregnancy because animal studies show fetal harm and human data are limited. The labels also flag that slowed gastric emptying can blunt oral-contraceptive absorption during titration. This card pulls the washout numbers, the inadvertent-exposure script, the contraception note, and the “Ozempic baby” phenomenon onto one page.
Pre-conception washout table
| Drug | Approximate half-life | Label-recommended washout before conception |
|---|---|---|
| Wegovy / Ozempic (semaglutide) | ~7 days | Discontinue at least 2 months before a planned pregnancy. |
| Zepbound / Mounjaro (tirzepatide) | ~5 days | Discontinue when pregnancy is recognized; the label advises against use in pregnancy and recommends planning around the drug’s exposure window. |
| Saxenda (liraglutide) | ~13 hours | Discontinue when pregnancy is recognized; short half-life means days, not months, but conception should be planned with the prescriber. |
| Foundayo (orforglipron, oral) | ~24 hours | Discontinue when pregnancy is recognized; planning a pregnancy should be discussed with the prescriber before stopping. |
The 2-month Wegovy figure is the only one written explicitly into the label and reflects how long it takes for semaglutide to clear after the last dose. Numbers above are reference points only — the actual decision is made with the prescriber and, ideally, a maternal-fetal-medicine (MFM) consultation.
Inadvertent exposure during early pregnancy
- Do not panic. The labels recommend stopping but do not list an automatic indication for pregnancy termination. Animal-study findings do not translate one-to-one to human risk.
- Document the exposure window. Last injection date, dose, weeks of gestation at exposure, and any concomitant medications. The MFM team needs the timeline.
- Stop the GLP-1 as soon as pregnancy is recognized. Continue prenatal vitamins, folate, and any other obstetric medications.
- Request an MFM consultation. Outcome counseling and any additional ultrasound surveillance happen there, not in primary care.
- Consider registry enrollment. Manufacturer pregnancy registries (Novo Nordisk for Wegovy/Ozempic; Lilly for Zepbound/Mounjaro) actively enroll exposed pregnancies to build the human safety record.
- Patients should discuss with the prescriber and MFM before any decisions about continuation, monitoring, or future use.
Contraception note
- Oral contraceptive absorption can drop with slowed gastric emptying. The Wegovy and Zepbound labels both flag reduced exposure of oral contraceptives, with Zepbound recommending a barrier method or a switch to a non-oral contraceptive for 4 weeks after starting therapy and after each dose escalation.
- Use barrier backup during titration. The first 4 weeks of starting a GLP-1 or stepping up a dose are when the gastric-emptying delay is most pronounced.
- Non-oral methods are unaffected. IUDs, implants, injectable contraceptives, the patch, and the ring bypass the absorption issue entirely.
- This is in the FDA label — it is not anecdote. Patients should ask the prescriber which method fits during titration.
Breastfeeding
- Labels say there are no data on the presence of semaglutide, tirzepatide, liraglutide, or orforglipron in human milk; effects on the breastfed infant and on milk production are unknown.
- The labels advise weighing benefits and risks with the prescriber. A conservative pump-and-discard approach is common in clinical practice while data are limited.
- Animal studies detected semaglutide in rat milk. That signal drives the cautious labeling but does not establish human risk.
- Patients should discuss timing of restart after delivery with both the prescriber and a lactation consultant.
The “Ozempic baby” fertility story
Reports of unplanned pregnancies on GLP-1s — popularly “Ozempic babies” — are largely a downstream effect of weight loss, not a direct drug effect on ovulation. In PCOS, weight loss of 5–10% restores ovulatory cycles in a meaningful fraction of patients, and GLP-1s deliver that magnitude of loss reliably. Contraception that was unnecessary during anovulation may now be needed, and the oral-contraceptive absorption issue above becomes more relevant.
Red flags — when to call MFM
- Positive pregnancy test while on a GLP-1. Stop the drug and call the prescriber the same day; MFM referral follows.
- Severe nausea and vomiting in early pregnancy after recent GLP-1 exposure. Hyperemesis plus a drug that slows emptying needs hands-on evaluation, not a portal message.
- Vaginal bleeding, severe abdominal pain, or signs of dehydration in any GLP-1-exposed pregnancy.
- Abnormal first-trimester screen or anatomy-scan finding in an exposed pregnancy — route to MFM, not general OB, for counseling.
- Active breastfeeding and a clinician wants to restart a GLP-1. That decision belongs with the prescriber and a lactation specialist together.
What this cheat sheet does not cover
Assisted-reproduction (IVF, IUI) protocols vary by clinic and most reproductive endocrinologists set their own pre-cycle washout windows that are stricter than the package insert — ask the REI team directly. Compounded GLP-1s have no pregnancy or lactation data of any kind: they are not FDA-approved and extrapolation from brand-drug labels is speculation. Diabetes-specific pregnancy management is out of scope and belongs with endocrinology and MFM.
Related on Weight Loss Rankings
- All cheat sheets — the full one-page reference library.
- GLP-1 Sick-Day Guide — flu, stomach bug, surgery, and the dehydration overlap with pregnancy risk.
- Wegovy Dose Ladder Cheat Sheet — the titration schedule a planned washout maps back onto.
- GLP-1 Q&A hubs — community questions about pregnancy, fertility, and contraception answered with sourced citations.
Sources
- DailyMed. WEGOVY (semaglutide) injection prescribing information. SetID ee06186f-2aa3-4990-a760-757579d8f77b. Sections: Pregnancy (8.1) — discontinue at least 2 months before a planned pregnancy; Lactation (8.2) — no data in human milk; Drug Interactions (7) — oral medications and gastric emptying.
- DailyMed. OZEMPIC (semaglutide) injection prescribing information. SetID adec4fd2-6858-4c99-91d4-531f5f2a2d79. Sections: Pregnancy (8.1) — potential risk to fetus; Lactation (8.2) — no data in human milk.
- DailyMed. ZEPBOUND (tirzepatide) injection prescribing information. SetID 487cd7e7-434c-4925-99fa-aa80b1cc776b. Sections: Pregnancy (8.1); Lactation (8.2); Drug Interactions (7.1) — oral hormonal contraceptives, barrier method recommended for 4 weeks after initiation and after each dose escalation.
- DailyMed. MOUNJARO (tirzepatide) injection prescribing information. SetID d2d7da5d-ad07-4228-955f-cf7e355c8cc0. Sections: Pregnancy (8.1); Lactation (8.2); Drug Interactions — oral hormonal contraceptives.
- Novo Nordisk and Eli Lilly pregnancy outcome registries. Active enrollment of GLP-1- and GIP/GLP-1-exposed pregnancies for prospective outcome data.
- Legro RS, et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. Weight loss of 5–10% restores ovulatory cycles in PCOS — the mechanism behind the “Ozempic baby” phenomenon.