Breastfeeding While Taking Semaglutide
Breastfeeding is not recommended while taking semaglutide due to insufficient human safety data, and the medication should be discontinued at least 2 months before planned breastfeeding given its long washout period.
FDA Drug Label Guidance
The FDA label for semaglutide explicitly states there are no data on the presence of semaglutide in human milk, effects on the breastfed infant, or effects on milk production 1. The label recommends that "the developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for OZEMPIC and any potential adverse effects on the breastfed infant" 1. Importantly, semaglutide should be discontinued at least 2 months before a planned pregnancy due to its long washout period (approximately 1 week half-life), which would similarly apply to breastfeeding considerations 1.
Clinical Considerations for Lactation
Key contraindication from expert consensus: The 2020 American College of Cardiology guidelines specifically list "the patient is breastfeeding" as a consideration that may prompt caution or avoidance of GLP-1 receptor agonists like semaglutide 2. This represents high-level guideline evidence against use during lactation.
Recent Research Evidence
A 2024 study measuring semaglutide transfer into human milk found no detectable levels in milk samples from 8 women at 0,12, and 24 hours post-administration 3. The calculated worst-case relative infant dose (RID) was 1.26%, well below the 10% safety threshold 3. However, this single study has important limitations:
- Very small sample size (n=8) 3
- Questions remain about long-term infant outcomes and maternal nutrient adequacy 3
- The authors themselves note that while concentrations appear low, comprehensive safety data are lacking 3
A 2023 systematic review examining GLP-1 agonists during pregnancy and lactation found that in animal studies, these medications were excreted in breast milk, but human data on excretion were not available 4. The review broadly supports discontinuing GLP-1 agonists during lactation due to insufficient safety data 4.
Alternative Diabetes Management During Breastfeeding
For lactating women requiring diabetes management:
- Insulin remains the gold standard and is safe during breastfeeding, though lactating women typically require less insulin due to calories expended with nursing 2
- Metformin is excreted into breast milk but does not appear to have harmful neonatal effects in limited studies, though larger studies are needed 2
- Glyburide or glipizide can be safely used by breastfeeding women 2
- Breastfeeding mothers often require a carbohydrate-containing snack before or during nursing to prevent hypoglycemia 2
Common Pitfalls to Avoid
- Do not assume newer diabetes medications are safe during lactation without specific evidence—the lack of data does not equal safety 5
- Do not start semaglutide in a breastfeeding woman even if planning to wean soon, given the 2-month washout period required 1
- Monitor for maternal nutritional adequacy if weight loss medications were used during pregnancy, as lactation requires approximately 500 additional calories per day 6
Clinical Algorithm
- If patient is currently breastfeeding: Do not initiate semaglutide 2, 1
- If patient is on semaglutide and wishes to breastfeed: Discontinue semaglutide at least 2 months before initiating breastfeeding 1
- For diabetes management during lactation: Transition to insulin, metformin, or second-generation sulfonylureas 2, 5
- If patient has gestational diabetes postpartum: Breastfeeding is strongly recommended and can be safely combined with insulin therapy 2