Is it safe to use GLP-1 (Glucagon-like peptide-1) receptor agonists, such as exenatide (Byetta), liraglutide (Victoza), or semaglutide (Ozempic), while breastfeeding?

GLP-1 Receptor Agonists While Breastfeeding

GLP-1 receptor agonists such as exenatide, liraglutide, and semaglutide should be avoided during breastfeeding due to insufficient safety data and potential risks to the infant. 1, 2

Safety Concerns in Breastfeeding

• The FDA drug label for liraglutide (Victoza) explicitly states: "It is not known if liraglutide passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using liraglutide injection." 1

• A 2023 systematic review found that in animal studies, GLP-1 agonists were excreted in breast milk, but human data on excretion were not available, supporting the recommendation to discontinue these medications during lactation. 2

• The 2025 EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation list several medications that should be avoided during breastfeeding due to insufficient data rather than evidence of harm, but do not specifically mention GLP-1 receptor agonists, suggesting they have not been established as safe. 3

Evidence from Animal Studies

• Animal studies have shown that GLP-1 receptor agonists are excreted in breast milk and can affect neonatal growth. 2

• Preclinical studies in small animals exposed to GLP-1 receptor agonists during pregnancy demonstrated adverse outcomes in offspring, including decreased fetal growth, skeletal and visceral anomalies, and embryonic death. 4

Potential Risks and Side Effects

• GLP-1 receptor agonists are associated with significant side effects that could potentially affect a breastfeeding mother's health and indirectly impact infant care, including:

  • Gastrointestinal disorders, particularly nausea, vomiting, and diarrhea 5, 3
  • Pancreatitis, which was the most frequently reported serious adverse reaction 5, 6
  • Potential risk of thyroid C-cell tumors 1, 3

• The 2023 Obesity Consensus on Care and Management notes that GLP-1 receptor agonists (specifically liraglutide and semaglutide) list "pregnancy and breastfeeding" as contraindications. 3

Clinical Recommendations

• Alternative glucose-lowering medications with established safety profiles during lactation should be considered for breastfeeding women with diabetes. 3

• For women using GLP-1 receptor agonists for weight management, it is recommended to discontinue these medications before attempting to conceive and throughout breastfeeding. 3, 4

• A 2025 review in the American Journal of Obstetrics and Gynecology recommends that all patients use contraception to prevent unintended pregnancy while taking GLP-1 receptor agonists due to insufficient safety data. 4

Important Considerations

• The benefits of breastfeeding are significant for both mother and infant, including protection against infectious diseases for the infant and reduced risks of various diseases for the mother. 3

• When considering medication use during breastfeeding, the potential risk of drug therapy for the child should be weighed against the risk of untreated maternal disease. 3

• If diabetes management is necessary during breastfeeding, medications with established safety profiles such as insulin or metformin should be considered as alternatives. 3

Conclusion

Based on the current evidence, GLP-1 receptor agonists should be avoided during breastfeeding due to insufficient safety data and the potential for adverse effects. Women requiring diabetes management while breastfeeding should consult with their healthcare providers about alternative medications with established safety profiles during lactation.