By Lew Kizer — 2026-10-28 — Health & Nutrition
The short answer
In October 2026 the American College of Obstetricians and Gynecologists (ACOG) issued a practice advisory on GLP-1 medicines in pregnancy and lactation. It says to consider stopping GLP-1s 1 to 2 months before trying to conceive, advises against using them during pregnancy, and calls for shared decision-making about use while breastfeeding, with close monitoring of the baby's weight. It advises against use when breastfeeding preterm infants and newborns.
Key facts
- Document: ACOG practice advisory, "Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation," October 2026; reported Oct. 23, 2026.
- Before pregnancy: counsel that safety data are lacking; consider stopping GLP-1s 1 to 2 months before conception.
- During pregnancy: ACOG advises against GLP-1 use.
- Breastfeeding: shared decision-making; if used, closely monitor infant weight gain with the baby's clinician.
- ACOG advises against GLP-1 use while breastfeeding preterm infants and newborns.
- Lead author Dr. D. Yvette LaCoursiere said as many as one in 300 women are exposed to GLP-1s before pregnancy.
- An August 2026 international review of 34 studies found no reports of increased birth-defect risk in about 1,538 exposed pregnancies, most of them inadvertent first-trimester exposures.
KINGSPORT, Tenn., Oct. 28, 2026 — For the first time, the American College of Obstetricians and Gynecologists has issued a practice advisory on using GLP-1 medicines such as semaglutide and tirzepatide before, during and after pregnancy. The guidance, reported Oct. 23, gives couples planning a family a clearer timeline: consider stopping 1 to 2 months before trying to conceive.
This article reports medical news and is not medical advice. Talk with your prescriber before you start, stop or change any medicine.
What ACOG recommends
| Stage | ACOG advice |
|---|---|
| Before pregnancy | Counsel that safety data are lacking. Consider stopping GLP-1s 1 to 2 months before conception. Encourage lifestyle support and monitor weight after stopping. Discuss reliable contraception with patients who do not want to become pregnant. |
| During pregnancy | Advise against GLP-1 use. Encourage lifestyle support and monitor weight gain during and after pregnancy. |
| Breastfeeding | Use shared decision-making to build a postpartum plan that may include GLP-1s. If used, closely monitor the baby's weight gain with the baby's clinician. Advise against use when breastfeeding preterm infants and newborns. |
Lead author Dr. D. Yvette LaCoursiere told ACOG that "as many as one in 300 women are exposed to GLP-1s prior to pregnancy." On breastfeeding, she said "there is not adequate safety data or information on the long-term effects," and that when a GLP-1 is chosen, "it is prudent to select the ones with shorter half-lives," as reported by Healio.
What the safety research shows so far
Pregnant women were excluded from the big GLP-1 trials, so the evidence comes from people who got pregnant while taking them. A 2024 study of women with type 2 diabetes found early-pregnancy GLP-1 use did not carry a greater risk of major birth defects than insulin. An August 2026 international review of 34 studies found none reporting increased birth-defect risk among about 1,538 exposed pregnancies, most of them unplanned and limited to the first trimester, according to Becker's Hospital Review. Reassuring, but small, which is why ACOG still says to stop before pregnancy.
When the medicine stops, the appetite comes back
Stopping a GLP-1 often means hunger and food noise return, sometimes quickly. ACOG specifically encourages lifestyle support and weight monitoring after stopping. In practice that usually means a plan before the last dose: regular meals, steady protein and portions you do not have to think about.
- Our GLP-1 maintenance meals page covers eating after you come off a medicine.
- The GLP-1 meal planning guide and the 7-day GLP-1 meal plan are illustrative starting points, not prescriptions. Pregnancy nutrition needs should come from your OB-GYN or a registered dietitian.
- After the baby arrives, postpartum meal delivery can keep the fridge full during the newborn weeks.
“We heal in community. We thrive in community. That's what Smash Meals is trying to be — not just a food company, but a community.” — Lew Kizer, Founder, SmashMeals
Commentary, not medical advice
The SmashMeals perspective
Coming off a GLP-1 to start a family is a big change. Appetite often comes back, and food noise with it, right when you want to eat well for two. That is a season when a stocked fridge of portioned, protein-forward meals can take one worry off the list. We are not your doctor. We are the kitchen.
Frequently asked questions
How long before getting pregnant should I stop a GLP-1?
ACOG's October 2026 advisory says clinicians should consider stopping GLP-1 medicines 1 to 2 months before conception. Your prescriber and OB-GYN can set the right timing for your medicine.
Can I take Ozempic, Wegovy or Zepbound while pregnant?
ACOG advises against GLP-1 use during pregnancy because safety data are lacking. If you become pregnant while taking one, call your prescriber.
Can I use a GLP-1 while breastfeeding?
ACOG calls for shared decision-making. If a GLP-1 is used while breastfeeding, the baby's weight gain should be closely monitored with the baby's clinician. ACOG advises against use when breastfeeding preterm infants and newborns.
Do GLP-1s cause birth defects?
Current evidence has not shown increased birth-defect risk, but it is limited. An August 2026 review of 34 studies covering about 1,538 exposed pregnancies, most of them early and unplanned, found no study reporting increased risk. That is why ACOG still advises stopping before pregnancy.
What should I eat after stopping a GLP-1?
ACOG encourages lifestyle support and weight monitoring after stopping. Many people find regular, portioned meals with steady protein helpful as appetite returns. A registered dietitian or your OB-GYN can tailor a plan for pregnancy.
Sources and credits
Follow the original sources for context and verification. A reference is not an endorsement of SmashMeals.
- Use of Glucagon-Like Peptide-1 Receptor Agonists in Pregnancy and Lactation (Practice Advisory) (opens in a new tab)
American College of Obstetricians and Gynecologists
Why it matters: The guidance itself.
- ACOG Releases New Guidance on the Use of GLP-1s in Pregnancy and Lactation (opens in a new tab)
American College of Obstetricians and Gynecologists
Why it matters: ACOG's announcement and the lead author's comments.
- ACOG issues 'long-awaited' guidance on GLP-1s during pregnancy, lactation (opens in a new tab)
Healio
Why it matters: Detailed summary of each recommendation and outside expert reaction.
- How the evidence on GLP-1s and pregnancy has changed: 6 notes (opens in a new tab)
Becker's Hospital Review
Why it matters: Timeline of the safety evidence, including the August 2026 international review.
- Preconception, pregnancy, and postnatal use of GLP-1 receptor agonist-based therapies in women with diabetes: systematic review, meta-analysis and international expert consensus (opens in a new tab)
The Lancet Obstetrics, Gynaecology, & Women's Health
Why it matters: The broader evidence review in women with diabetes.