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ACOG Issues New Guidance on GLP-1 Drugs Before Pregnancy, During Pregnancy and While Breastfeeding · GLP-1 Newspaper: Daily Ozempic, Zepbound & Weight-Loss Drug News

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  Welcome to the GLP-1 Newspaper, your daily update
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  on the news shaping GLP-1 and weight loss medications.
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  Visit glp1newspaper.com to see today's stories
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  and sign up for email alerts. Thank you so much
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  for joining us today. Yeah. So today we are putting
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  a singular focus on a really critical intersection
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  in the medical field right now, which is navigating
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  GLP-1 medications and pregnancy. Right, because
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  as prescribing rates for these medications keep
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  rising, we're looking at a pretty massive evidence
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  gap regarding maternal and fetal safety. Exactly.
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  And to set the stage for you, we have to look
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  at the current landscape. According to Dr. D.
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  Yvette LaCoursiere, who is the lead author of newly
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  released guidance from ACOG. That's the American
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  College of Obstetricians and Gynecologists, just
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  for anyone unfamiliar with the acronym. Right,
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  ACOG. Well, according to her, as many as 1 in
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  300 women are currently exposed to GLP-1s prior
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  to pregnancy. 1 in 300. I mean, that is a staggering
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  number when you zoom out. And with these medications
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  becoming increasingly accessible online and at
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  medical spas, that exposure likelihood is just
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  heightening. It really is. And that's exactly
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  what prompted ACOG to release specific recommendations
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  for clinicians. So let's start with the period
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  before pregnancy even begins. Preconception.
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  ACOG's specific recommendation to clinicians
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  is that they should consider having patients
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  stop GLP-1 medications one to two months before
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  trying to conceive. Yeah, one to two entire months.
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  Which, you know, feels like a really long time
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  to just wait after stopping a drug. But it makes
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  sense if you think about it like an engine. It's
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  kind of like letting the engine fully clear out
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  before starting a completely new journey. That's
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  a great way to visualize it, yeah. Because of
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  the long half-lives of these medications, it
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  takes weeks for the body to actually fully clear
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  them. It's not an overnight thing. Right. You
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  can't just stop taking it on a Friday and be
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  clear by Monday. Exactly. And ACOG also brings
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  up a really important point about fertility here.
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  Oh, right. Because the weight loss associated
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  with GLP-1s can actually improve fertility.
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  Yes. Both spontaneous and assisted conception
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  can improve. So ACOG recommends that clinicians
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  need to speak with patients who do not wish to
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  become pregnant about using reliable contraception.
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  Because obviously, if you're on the medication
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  and suddenly your fertility improves, you could
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  find yourself in a situation where you get pregnant
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  before you even have a chance to do that one
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  to two month clearance window. Precisely. It's
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  a huge clinical consideration right now. OK,
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  so that logically leads us to the next big question.
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  If clinicians are advising patients to stop the
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  medication before getting pregnant, what are
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  the actual physical effects of that discontinuation?
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  Well, this is where a newly published study in
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  JAMA by Maya et al. comes into play. Okay, let's
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  unpack that. But we need to strictly frame this
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  first. This is an observational study. It found
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  an association. It is absolutely not proof that
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  stopping the drugs causes harm. Right. That distinction
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  is so important for you listening. It's an association,
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  not a direct proven cause. Exactly. So looking
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  at the exact findings, they looked at a cohort
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  composed primarily of women with obesity. Okay.
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  And those who were prescribed GLP-1s with discontinuation
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  before or in early pregnancy experienced a mean
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  gestational weight gain of 13.7 kilograms. 13.7
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  kilograms. Okay. But how does that compare
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  to people who weren't on the drug? So they looked
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  at propensity-matched unexposed pregnancies,
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  and in that group, the mean weight gain was 10.5
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  kilograms. Okay, so that's a difference of
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  3.3 kilograms. Right, exactly. The exposed group
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  gained 3.3 kilograms more, but did that translate
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  to other risks? It did. The study listed specific
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  comparative figures for the exposed group versus
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  the unexposed group. For instance, there was
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  a higher risk of preterm delivery. It was 17%
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  versus 13%. Okay. And for gestational diabetes,
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  it was 20% in the exposed group compared to
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  15% in the unexposed. Wow. Yeah. And for hypertensive
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  disorders of pregnancy, they saw 46% compared
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  to 36%. Wait, I have to jump in here. If they
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  stop taking the drug, are these higher risks
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  actually being caused by the medication exposure?
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  Or is this just the body rebounding after an
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  obesity treatment is removed? That is the crucial
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  question. And it highlights a key limitation
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  of the Maya et al. study. Oh, really? How so?
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  Well, the researchers matched patients based
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  on their pre-pregnancy BMI. They did not match
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  them based on their BMI from before they started
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  the GLP-1 treatment. Oh, I see. So you're looking
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  at someone who maybe just lost a lot of weight
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  on the drug and comparing them to someone who
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  naturally maintained that same BMI without the
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  drug. Exactly. The metabolic baselines are completely
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  different. And this actually aligns perfectly
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  with ACOG's caution to clinicians. Which is that
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  regaining weight after discontinuation is common,
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  right? Yes. ACOG notes that this rebound weight
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  gain is common and may increase the risk of adverse
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  outcomes. Which is why they encourage clinicians
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  to really monitor their patient's weight and
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  counsel them on lifestyle interventions during
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  that period. You can't just stop the drug and
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  walk away. Right. It requires very active management.
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  Okay. So moving the timeline forward chronologically.
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  What does ACOG tell clinicians to do once a patient
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  is actively pregnant? ACOG's guidance here is
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  very clear. Clinicians are advised against the
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  use of GLP-1s during pregnancy except within
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  a clinical trial. And I just want to clarify
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  that language really quickly for you listening.
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  They are strongly recommending against it to
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  clinicians based on a lack of data, but they
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  never actually call it a firm prohibition or
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  a ban. That's a great point. It's not an outright
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  ban, but the why behind the guidance is pretty
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  compelling. Right, because of the animal studies.
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  Yes. ACOG attributes their reasoning directly
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  to animal studies, which showed associations
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  with decreased fetal weight, growth restriction,
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  and abnormal bone development. Yeah, which obviously
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  raises immediate concerns for human pregnancies.
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  Definitely. And additionally, ACOG points out
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  that GLP-1 use could result in inadequate intake
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  of nutrient-dense foods. Oh, because the medication
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  makes you feel full so quickly. Exactly. So patients
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  might not get the essential vitamins and minerals
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  that are just vital during a pregnancy. That
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  makes total sense. You physically just can't
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  eat enough of the good stuff. But to add some
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  balance here, what does ACOG say about the human
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  data we actually do have? Well, ACOG notes that
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  available human data has not demonstrated a consistent
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  increase in birth defects. Which is somewhat
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  reassuring. It is. And they also mentioned that
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  because GLP-1s are large peptide molecules,
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  transplacental passage is thought to be unlikely.
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  Meaning the drug molecules are too big to easily
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  cross the placenta to the fetus. Exactly. But
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  even with that, the safety data we have is just
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  far too limited right now. Hence the strong advice
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  against use. Yeah, that makes sense. You just
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  can't risk the unknowns. OK, so moving to the
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  final stage of the timeline, the postpartum period
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  and breastfeeding. Right. Lactation. What is
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  ACOG advising there? For lactation, ACOG advises
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  obstetricians to engage in shared decision-making
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  with their patients. Meaning they need to sit
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  down and create a customized postpartum care
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  plan together. Yes, and that plan can potentially
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  include GLP-1s. But there are some really crucial
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  exceptions here that ACOG emphasizes, right?
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  Very crucial. ACOG recommends against use while
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  nursing preterm infants. Okay. And they also
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  recommend against use for newborns in the first
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  28 days of life. And I want to stress for you
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  listening that ACOG stated those parameters without
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  providing the underlying physiological reasons
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  in this specific guidance. So we aren't going
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  to guess or speculate as to why that 28-day
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  window exists. Right. We just report what they
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  advise the clinicians. Now, for infants outside
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  that window, if a patient does use GLP-1s while
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  breastfeeding, ACOG advises close surveillance.
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  Meaning monitoring the infant's weight gain,
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  right? Exactly. In close concert with the infant's
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  healthcare professional, like their pediatrician.
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  Okay. Did ACOG give any guidance on which specific
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  medications might be preferred if they do decide
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  to use them postpartum? They did mention that
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  if a patient chooses to use GLP-1s while lactating,
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  despite the limited data, it's prudent to select
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  medications with shorter half-lives. Okay. Like
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  what? They specifically used exenatide as an
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  example. Right. And again, this is strictly what
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  ACOG told clinicians to consider. It's definitely
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  not a how-to guide or prescribing advice for
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  you listening at home. Definitely not. It's just
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  a clinical strategy they mentioned to help mitigate
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  the unknown risks. You know, looking at this
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  whole picture, it just reflects this incredible
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  balancing act for both clinicians and patients
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  right now. It really does. Everyone is kind of
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  caught in this giant evidence gap. You're forced
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  to weigh the really well-documented risks of
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  obesity and that rapid rebound weight gain against
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  the totally unknown variables of early GLP-1
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  exposure. It's a tough spot to be in. It perfectly
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  highlights how incredibly fast GLP-1 medicine
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  is moving and how urgently maternal safety research
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  just needs to catch up. Absolutely. The research
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  just has to catch up to the reality on the ground.
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  Thanks for listening to the GLP-1 Newspaper.
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  This show is for information only and is not
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  medical advice, so always talk to your doctor
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  before starting, stopping, or changing any medication.
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