GLP1 in pregnancies

[Purpletree]

Hi,

I began tirz under a month ago, at 88.6kg and 161cm, and I'm 26 y/o. Down the road, we do want a second child — but only once I've reached my target of roughly 55kgs. So I went hunting for information on staying on it while pregnant and came up with basically nothing, apart from one reddit user who discovered her pregnancy near the third trimester, quit the medication, and her baby was fine. I realize it sounds selfish, but I keep wishing I could stay on even a microdose of tirz through a pregnancy, because otherwise I picture the standard pregnancy weight gain plus the return of the ravenous hunger once I stop. That seemed semi-tolerable until I came across the claim that tirz works noticeably less well the second time around, and I've also seen doctors suggest that one day continuing glp1's in pregnancy could be medically accepted, since obesity counts as a chronic disease and lifetime medication is needed… After I eventually shed the weight, I just don't know how to feel knowing I'd put it all back on plus extra from the pregnancy. Sure, regaining everything isn't guaranteed, but I went on tirz because of overwhelming food noise, and I know that comes straight back the moment I quit, so I assume I'll be one of those who regain.

Any perspective is welcome. I'm not after medical advice at all, just opinions. I'm fairly certain plenty of others share this same fear.

 

[DunningKruger]

It makes total sense that this is on your mind. When you've at last discovered something that turns down the volume on food noise, the thought of stopping it can feel frightening.

That said, if another child is what you're aiming for, I would put that above all else.

As things stand, the guidance is to discontinue GLP-1 drugs before attempting conception, since the human safety evidence simply isn't there yet to establish that they're safe in pregnancy. A single encouraging anecdote on Reddit doesn't prove the risk is small, and it isn't a green light to take that same gamble.

There's also a strong posting bias: those with healthy outcomes are far more inclined to share their stories than those who aren't.

Consider this: if the pregnancy went wrong in some way, even with no way for anyone to ever establish that the medication was involved, would you be left forever asking yourself if it was?

For me, that thought by itself would settle it as a hard no.

If food noise or weight gain is what worries you, I'd tackle that prior to conception. Come off it step by step with your prescriber, raise calories gradually as your body needs, and allow yourself time to adapt before you start trying to conceive. That issue is solvable. What can follow from taking avoidable risks in pregnancy sometimes isn't.

 

[eidos]

Only a tiny fraction of drugs get studied in pregnant people, since there are possible dangers to the embryo/fetus.

When it comes to GLP-1 analogs, our knowledge is extremely limited, and I have not come across any information about gestation.

Since it seems like you aren't factoring these in, let me point out a few biological realities.

For the fetus to develop and remain viable, it requires high-quality nutrition. Your body's demands should guide what you eat; instinct handles that job. There are a few odd exceptions where taste shifts, but those around you will point them out.

Women accumulate stores matching the energy required for breastfeeding until the next plentiful season. Nature lacks a smartphone to verify the date, so this reserve is designed to last roughly a year. That is how our ancestors made it through and how we are here now.

Should you prefer not to breastfeed, pumping and donating your milk is an option, and it will also assist with losing fat. Later on, you'll have ample opportunity to restart the Reta.

And as everyone will say, pregnancy gives you a glow.

 

[ohemaaluxe]

I shared the same worries you have — pregnancy plus weight gain. My own story: 4 months on tirz, then I had to quit (30lbs down), and within the following few months every pound came back and then more. I restarted tirz and dropped 45 pounds. The moment I dipped below 200lbs, I learned I was pregnant (currently 6 months along). One thing I can say for sure: the second round of tirz felt a bit less "effective," though really it was that I couldn't remain at the lower doses for the same stretch as round 1. Appetite suppression and the rest were still fully present. Once I knew I was pregnant, weight gain terrified me, but — lucky or unlucky, depending on your perspective lol — food noise was basically absent, and I actually shed pounds during my first trimester because of severe food aversion and vomiting. In my second trimester now, I've put on 6 pounds, and food noise is still gone. So I'm working on not obsessing over the scale, since weight gain is expected and what matters most to me is a healthy baby.

Do I intend to get straight back on tirz after giving birth and breastfeeding for a few months? Absolutely lol. My stash sits there waiting patiently. For the moment, though, I'm just relieved to have peace of mind that I'm not doing anything that could potentially harm the baby.

My advice: try not to stress about it too much, and put your energy into getting as healthy as you can before you try to conceive, because that makes a huge difference. Losing those 45 pounds beforehand was such a gift — it has made my pregnancy MUCH more comfortable.

 

[lessthanhalf]

Up to now, multiple studies have looked at women who used GLP medications before realizing they were pregnant — meaning exposure was limited to early pregnancy — and who then discontinued. Those studies found no meaningful rise in fetal malformations, miscarriages, or poor outcomes. Part of what makes this possible is that these drugs can boost fertility for some women.

So if you conceive while on them and then stop, it is not a catastrophe. Still, the guidance is to discontinue 1 month or 2 before you start trying to conceive.

The brain contains a huge number of neurones, and GLP receptors and GIP receptors are found at other sites too. Nobody has even a slight clue what these drugs could or could not do to those neurones as they develop in the fetus, nor whether there are damaging metabolic consequences for the fetus during growth. (Might fetal blood sugar drop, altering growth?) On the surface, there are strong grounds to avoid exposing a developing baby to GLP's; it is simple to imagine how harm could arise. Studies will not be run, because doing them would be judged unethical and too risky for the fetus. So, as with many medications in pregnancy, the advice will be to steer clear unless there is no alternative. Long term, the medical dangers of stopping GLP drugs are fairly small, unlike medications required to preserve the mother's health during pregnancy, where necessity outweighs potential harm — treating high blood pressure or epilepsy, for instance. I doubt solid answers about their safety in pregnancy will arrive soon. Typically, reliable data only accumulates through analysis of large numbers of people who took the drug accidentally while pregnant, which can take decades. Nobody wants to conduct prospective trials on drug safety in pregnancy; it would be a minefield.

Excess weight gain during pregnancy is not ideal either, yet no one will advise continuing GLP drugs to prevent it. Naturally, you can always begin them again once the baby is born, even if that means putting some weight back on and having to shed it once more. At least these drugs are available today — that choice did not exist only a few years ago. I fully understand not wanting to quit them, since I depend on them to keep off 55% of my body weight, but certain risks are not worth accepting.