From the Guidelines
GLP-1 receptor agonists are not recommended during lactation due to limited safety data and potential risks to the nursing infant. The safety profile of Glucagon-like peptide-1 (GLP-1) receptor agonists in lactation is not fully known, as stated in a recent review published in JAMA 1. This lack of knowledge raises concerns about the potential effects of these medications on infant growth and development. Although animal studies have shown that GLP-1 receptor agonists can pass into milk, the molecular size of these medications suggests limited transfer into breast milk. However, without conclusive human data, caution is warranted.
Key Considerations
- The American College of Obstetricians and Gynecologists recommends metformin as a second-line medication for diabetes during pregnancy, and it is considered safe during lactation 1.
- GLP-1 receptor agonists can decrease the effectiveness of oral contraceptives due to delayed gastric emptying, and the addition of a barrier method is recommended for 4 weeks after initiation of a GLP-1 receptor agonist and after each dose increase 1.
- For breastfeeding mothers requiring diabetes management, insulin is typically preferred as it has a well-established safety profile during lactation.
- Women taking GLP-1 medications who wish to breastfeed should discuss the risks and benefits with their healthcare provider, as individual circumstances may influence the decision-making process.
Alternative Options
- Metformin may be considered as an alternative for breastfeeding mothers requiring diabetes management, as it has a more established safety profile during lactation 1.
- Insulin is generally preferred for diabetes management during lactation due to its well-established safety profile.
Decision-Making
The potential benefits of breastfeeding must be weighed against the theoretical risks of medication exposure to the infant. Healthcare providers should discuss the risks and benefits of GLP-1 receptor agonists with breastfeeding mothers, considering individual circumstances and alternative treatment options. In general, it is recommended to avoid GLP-1 receptor agonists during lactation until more conclusive human data becomes available.
From the Research
Safety Profile of GLP-1 Receptor Agonists
The safety profile of Glucagon-like peptide-1 (GLP-1) receptor agonists in lactation is not directly addressed in the provided studies. However, the studies discuss the safety and efficacy of GLP-1 receptor agonists in general.
Adverse Events
- Gastrointestinal adverse events, such as nausea, vomiting, and diarrhea, are common with GLP-1 receptor agonists, but are generally mild to moderate in severity and transient 2, 3, 4, 5.
- The risk of hypoglycemia is low, but may be increased when used with insulin secretagogues or insulin 2, 5.
- Injection-site reactions are also possible, particularly with longer-acting formulations 3, 5.
- Pancreatitis, neoplasms, and gallbladder events are rare, but have been reported in some cases 5.
Special Considerations
- GLP-1 receptor agonists may be beneficial for patients with polycystic ovary syndrome (PCOS), particularly those who are overweight or obese, glucose intolerant, or have cardiovascular disease risk factors 6.
- The safety and tolerability of once-weekly GLP-1 receptor agonists, such as dulaglutide, exenatide extended-release, and semaglutide, have been evaluated in clinical trials, and are generally considered safe and well-tolerated 5.
Lactation Considerations
There are no research papers provided that directly address the safety profile of GLP-1 receptor agonists in lactation. Therefore, it is not possible to provide a comprehensive answer to this question based on the available evidence.