The other side of Glp-1: increasing use after childbirth and greater risks if discontinued before pregnancy
Two studies put the use of anti-obesity drugs in women of childbearing age under the microscope. Meanwhile, Novo Nordisk cashes in on the failure of Alzheimer's trials.
Key points
The global rise of Glp-1 anti-obesity drugs is generating new attitudes and new questions about their safety in delicate phases of women's lives. A large Danish study published in the Journal of the American Medical Association (Jama) captures a rapidly expanding phenomenon: the increase in prescriptions of Glp-1 agonists in the months immediately following childbirth.
Danish study: semaglutide boom in postnatal care, but few safety data
The analysis, conducted on the basis of national health registers, considered more than 382 thousand pregnancies in Denmark from 2018 to 2024. As of the end of 2021, the use of semaglutide within six months of delivery grew exponentially: from one in every 300 users in 2022 to one in every 57 in mid-2024. The profile of the patients clearly indicates that the main goal is weight loss, not the treatment of diabetes, but this is at a time - the postpartum - when the safety of the drug is poorly documented and data on the effects on lactation and the newborn are still insufficient.
Experts urge caution. 'These substances have been on the increase recently and little is known about their effect on women taking them in the post-partum period and also about the possible effects on the newborn during breastfeeding,' observes Marco Marano, head of the Poison Control Centre at the Bambino Gesù Hospital and a member of Sitox. Concern shared by the president of the Italian Society of Pharmacology, Armando Genazzani, who recalls that in the technical data sheet of semaglutide 'it is written that it should not be taken during pregnancy' and that 'it should not be used during breastfeeding, because animal studies show that it can pass into breast milk'. Genazzani adds that the Danish study 'takes a snapshot of what is happening', but important clinical details, such as the lactation status of the patients, are missing. "We need to monitor this phenomenon and be careful that it does not become a shortcut to losing weight after pregnancy. It is important that use is always under medical supervision,' he concludes.
US study: Glp-1 interrupters before pregnancy gain more weight and have more complications
Adding to the Danish picture is a second study, also published in Jama, investigating the impact of discontinuing Glp-1 shortly before or at the start of pregnancy. Analysing 149,790 pregnancies in a large US health care system, the authors found that women who had discontinued semaglutide or other Glp-1s in the three years prior to conception had a higher average gestational weight gain, along with an increased risk of excessive weight gain, preterm delivery, gestational diabetes, and hypertensive disorders of pregnancy. These were mostly women with severe obesity, confirming that the use of the therapy was mainly aimed at weight control and then discontinued in view of motherhood. But this very discontinuation could alter the metabolic balance during pregnancy, increasing complications.
Two studies, therefore, looking at different times - the postnatal and pre-pregnancy phases - but drawing the same conclusion: a more rigorous evaluation of Glp-1 use in women of childbearing age is needed.
