Every FDA-approved GLP-1 and GIP/GLP-1 label warns of possible fetal harm and tells prescribers to stop the drug as soon as a pregnancy is recognized; none of them lists pregnancy as a contraindication, and only the two semaglutide labels set a pre-conception window. 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 figure appears on the Wegovy and Ozempic labels only — it is the only pre-conception window written into any GLP-1 label, and it reflects how long semaglutide takes 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.