Should a 22-year-old pregnant woman discontinue her weight-loss medication?

Discontinuation of Weight-Loss Medication in Pregnancy

Yes, she must stop the weight-loss medication immediately—all FDA-approved weight-loss medications are contraindicated in pregnancy. 1

Immediate Action Required

Stop the medication now. All weight-loss medications approved by the FDA are contraindicated in women who are pregnant or actively trying to conceive. 1 This is a universal contraindication across all drug classes used for weight management, including:

• Orlistat 1
• Phentermine (and phentermine/topiramate ER) 1
• Naltrexone/bupropion ER 1
• Liraglutide 3.0 mg 1
• Semaglutide 2.4 mg 1
• Tirzepatide 2, 3

Rationale for Discontinuation

Teratogenicity risk is the primary concern. Weight-loss medications carry potential teratogenic effects that pose unacceptable risks to fetal development. 4 Specifically:

• Phentermine/topiramate ER is associated with birth defects and cognitive impairment 1
• GLP-1 receptor agonists (liraglutide, semaglutide, tirzepatide) are contraindicated due to potential teratogenicity, though specific human data remain limited 4
• Naltrexone/bupropion carries a black box warning for suicidal behavior/ideation and is contraindicated in pregnancy 1

Clinical Management Approach

Discontinue immediately without tapering. Most weight-loss medications can be stopped abruptly without physiological withdrawal concerns. 2 The patient should:

1. Stop the medication at the current dose without stepwise reduction 2
2. Inform her prenatal care provider about the medication exposure and timing relative to conception 1
3. Expect weight regain during pregnancy, which is physiologically appropriate 2, 3
4. Focus on appropriate gestational weight gain rather than weight loss during pregnancy 1

Important Counseling Points

Weight loss during pregnancy is not recommended. Even for women with obesity, the goal shifts from weight loss to appropriate gestational weight gain and metabolic optimization. 1

Future contraception planning is essential. Women of reproductive potential should receive counseling regarding reliable contraception methods before restarting weight-loss medications postpartum. 1 This conversation should occur during prenatal care to plan for postpartum weight management.

Breastfeeding considerations. Weight-loss medications are also not recommended during lactation, so postpartum restart should be delayed until after breastfeeding is complete or an alternative feeding plan is established. 1

Common Pitfall to Avoid

Do not attempt to "taper" or continue at a lower dose. The contraindication is absolute and not dose-dependent—there is no safe dose of these medications during pregnancy. 1 Any continued exposure increases unnecessary fetal risk without maternal benefit.