Preconception Guidelines for Patients Taking Semaglutide
Women taking semaglutide must discontinue the medication at least 2 months before a planned pregnancy due to the long washout period and potential fetal risks. 1
Preconception Assessment and Counseling
Risk Assessment
- Semaglutide is contraindicated during pregnancy based on FDA labeling 1
- Animal studies have shown:
- Reduced maternal weight gain and food consumption
- Early pregnancy losses
- Increased incidences of fetal abnormalities including:
- Visceral abnormalities (heart blood vessels, kidney, liver)
- Skeletal abnormalities (cranial bones, vertebra, ribs, sternebra) 1
Contraception Requirements
- Women of reproductive potential should use effective contraception while taking semaglutide
- Women using oral hormonal contraception should:
- Use or add a non-oral contraception method for 4 weeks after semaglutide initiation
- Continue alternative contraception during dose escalations 2
- Note that semaglutide does not reduce the bioavailability of ethinylestradiol and levonorgestrel (components of oral contraceptives) 3
Preconception Timeline
Discontinuation Protocol
- Timing: Discontinue semaglutide at least 2 months before attempting conception 1
- Rationale: Semaglutide has a long half-life of approximately 1 week, requiring adequate washout time 1
- Monitoring: Continue pregnancy testing while on semaglutide and for 2 months after discontinuation
Glycemic Control Transition
For patients with type 2 diabetes:
- Work with healthcare provider to transition to pregnancy-safe diabetes medications
- Consider insulin or other antidiabetic medications with established safety profiles in pregnancy
- Aim for optimal glycemic control before conception (HbA1c <6.5% if possible)
Alternative Management Options
For Weight Management
- Structured weight loss program with dietary and lifestyle modifications 2
- Behavioral interventions focusing on caloric restriction and increased physical activity
- Consider consultation with registered dietitian
For Type 2 Diabetes
- Metformin may be continued during pregnancy planning and pregnancy (Category B)
- Insulin therapy is the preferred treatment during pregnancy
- Regular monitoring of blood glucose levels
Special Considerations
Monitoring After Discontinuation
- Regular assessment of glycemic control
- Weight monitoring
- Screening for complications of diabetes
Preconception Screening
- Complete evaluation of diabetes-related complications:
- Retinopathy assessment (semaglutide has been associated with worsening of diabetic retinopathy) 1
- Renal function testing
- Cardiovascular assessment
Pitfalls and Caveats
- Failure to discontinue semaglutide with adequate washout time before conception
- Inadequate contraception during semaglutide treatment
- Insufficient transition planning for glycemic control
- Lack of monitoring for potential worsening of diabetic retinopathy after discontinuation
- Underestimating the importance of achieving optimal glycemic control before conception
By following these guidelines, healthcare providers can help patients safely transition from semaglutide therapy to pregnancy planning while maintaining appropriate management of diabetes or weight concerns.