You might have heard in the news about a so called ‘wonder drug’ used for the management of type 2 diabetes, and also being prescribed by some healthcare professionals for weight loss.

For some, Ozempic is fast becoming the drug of choice for losing weight but, despite its recent popularity, questions regarding its safety in pregnancy are being raised.

Maybe you’re wondering whether Ozempic is right for you. Can you take Ozempic while pregnant?

Or you might be using it, at present, to lose weight and you’re wondering whether it’s safe for pregnant women.

If you’re struggling to lose weight or to conceive, Ozempic or other obesity medications could be tempting.

As with any new medication, however, it’s important to speak to your healthcare provider first, to discuss whether or not this is right for you, based on your own individual health circumstances.

Related reading: Gestational Diabetes | What You Need To Know.

What is Ozempic?

Ozempic was first approved in 2017 by the U.S Food and Drug Administration (FDA) for use in adults with type 2 diabetes; the drug helps with blood sugar control. When used appropriately alongside a balanced diet and lifestyle, it can improve both short and long term markers for blood sugar regulation, including fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) in those with type 2 diabetes.

People with type 2 diabetes who use Ozempic might experience loss of weight while using this medication. It is a common side effect. Ozempic is intended for long term use.

However, some prescribing healthcare providers are advocating the use of this diabetes medication ‘off-label’ (meaning, not for its intended purpose), to support those on weight management programs.

The problem is, the drug was never intended for this use. It was intended for those with poorly controlled diabetes, to help manage their blood sugar levels. Uncontrolled blood sugar (glucose) levels can lead to a number of health concerns, including heart disease, kidney failure and nerve damage.

Ozempic has never been tested specifically for the purpose of losing weight. It was tested on people with type 2 diabetes, therefore there is very limited data out there to prove its health outcomes outside this group and its original intended purpose.

How does Ozempic work?

Ozempic works by mimicking a naturally occurring hormone in the body. It fools the brain into a feeling of being full and, as a result, reduces appetite and food intake. It acts by slowing the passage of food through the digestive system, and also slows gastric emptying, leaving individuals feeling fuller for longer.

Ozempic increases the action of insulin, which the body uses to move glucose from the bloodstream to the cells for energy. It decreases the action of glucagon, which increases blood glucose levels to prevent them from getting too low. During this process, the amount of sugar that is absorbed from the diet is limited.

Ozempic and Wegovy: what’s the difference?

The active ingredient in Ozempic is , which is sold as a medication called Wegovy. This was approved for the purpose of weight loss in 2021semaglutide.

The difference between Ozempic and Wegovy is that Ozempic contains a smaller dose of semaglutide.

Weight loss with Wegovy is generally higher than that seen with Ozempic, but it is usually harder to get coverage from health insurance companies.

Both Ozempic and Wegovy are made by the same manufacturers, but Ozempic was developed specifically for patients with type 2 diabetes.

Are weight loss drugs safe?

It’s important to recognize that, with any weight loss program, there is no ‘quick fix’ or ‘magic cure’. Even individuals who opt for weight loss drugs or surgery still need to focus on maintaining a healthy lifestyle through diet and exercise. A healthy lifestyle plan is still needed to achieve maximum weight loss benefits.

Weight loss drugs can be used as an alternative to bariatric (weight loss) surgery, and might be appropriate for some people, based on their individual circumstances. However, surgery has greater long term effects and, after surgery, weight loss is also greater in comparison with taking medications alone.

Individuals who take anti-obesity medicine to lose weight will often stop once they achieve a healthy weight. Further weight gain is common, however, once those medications are stopped. Any lost weight is likely to be put on again and, therefore, the method isn’t effective for sustained weight loss.

Experts recommend individuals avoid using Ozempic unless they have type 2 diabetes.

Can I just stop taking Ozempic for weight loss?

Experts recommend you seek guidance from your doctor before stopping Ozempic, to reduce any potential risk. Your healthcare provider might suggest you transition from one medication to another, to slowly wean you off Ozempic.

Can I take Ozempic while pregnant?

Ozempic has never been approved for use in pregnant women, and is therefore not recommended.

Very little is known about Ozempic in pregnant patients or in those trying to get pregnant.

Little is known about the effects and how the drug might affect pregnancy or the unborn child. It has only ever been tested on pregnant animals; this is not uncommon, as medication trials on pregnant women is considered unethical.

Animal studies have shown Ozempic has potential risks, including fetal harm, major birth defects and pregnancy complications.

In a study based on pregnant rats, Ozempic was found to have a number of effects on fetal outcomes, including: increased early pregnancy losses; fetal harm; birth defects; low birth weight; increased still birth; and decreased viability of baby rats. These rats were given below the maximum recommended human dose of Ozempic.

Further animal studies and trials based on rabbits and monkeys showed increases in miscarriage, birth defects, structural abnormalities and birth complications.

It might not be possible to take what is known from animal data and apply it directly to human pregnancy; these findings, however, are significant and should not be ignored. It’s possible this medication could cause human fetal harm.

The American Diabetes Association recommends pregnant women, and those planning to become pregnant, avoid Ozempic due to its limited safety data.

When to stop Ozempic before pregnancy?

Ideally Ozempic should be stopped at least 2-3 months prior to becoming pregnant, to allow ample time for the medication to leave the body completely, and for the body to regain its normal hormone balance.

If you have become pregnant whilst taking Ozempic, speak to your health care providers as soon as possible, for information about how to stop taking it safely. Do not stop taking it on your own.

Can I take Ozempic while trying to get pregnant?

Due to the unknown effects of Ozempic on pregnant women, it’s recommended that those of reproductive age who are using Ozempic should also use a method of birth control, to prevent any unplanned pregnancies.

Does Ozempic affect fertility?

There is no evidence to suggest that Ozempic directly affects a woman’s fertility or fertility treatment. It’s well known, however, that poor nutrition, increased weight and body mass index (BMI) can affect an individual’s ability to conceive.

Being overweight or obese can create hormonal imbalances that can prevent ovulation or create irregular menstrual cycles. It’s known that even modest weight loss can affect hormonal processes, bringing the body back into balance. Increased weight in men can also affect testosterone levels, sperm quality and sexual function, further affecting fertility. Therefore, for some, Ozempic might enhance fertility.

However, Ozempic could have a negative effect on fertility, especially if weight loss occurs too quickly, as this can throw out other hormones, such as Lutenising hormone (LH) and Follicle Stimulating Hormone (FSH), which are needed for regular ovulation and menstruation.

Optimal weight, good nutrition and activity are all equally important for fertility and increase the chances of conception. They are also important factors for maintaining a healthier pregnancy.

For more information on infertility read our article Investigating Infertility | 7 Critical Preliminary Blood Tests

Weight loss in pregnancy

Actively losing weight in pregnancy is not recommended, even for those who are already overweight or obese.

Weight gain in pregnancy should be encouraged, regardless of an individual’s pre pregnancy weight. Gaining weight in pregnancy is normal and necessary for a healthy pregnancy. The weight gain is not solely down to the size of the baby but also due to increased blood volume, increase in maternal tissues (uterus, placenta, breast tissue etc) and amniotic fluid.

This obligatory weight gain should be encouraged for every pregnant patient. According to the CDC, not gaining enough weight in pregnancy could lead to an increased risk of birth complications, such as preterm birth, low birth weight and poor fetal growth.

How much weight someone should gain in pregnancy is based on individual health circumstances. In general, those who are overweight or obese should gain less than those of an optimal weight; those who are underweight should gain a little more compared with those of optimal weight.

Ozempic while breastfeeding

There is little known data on the effects of Ozempic on breastfeeding. There is no evidence to support the use of Ozempic during breastfeeding, as it is unclear whether the medication is passed through breast milk, potentially affecting an infant’s metabolism.

More research is needed on this topic to understand fully the potential risks; however, drug manufacturers are putting together a registry to follow the health outcomes for women exposed to selmaglutide during pregnancy and breastfeeding. The results of these are not expected to be completed before 2027.

To learn more about weight loss if you’re breastfeeding, read our article Questions About Weight Loss During Breastfeeding

Are there alternatives to Ozempic?

Metformin is usually the preferred medication for those with type 2 diabetes. For certain individuals, however, Ozempic might be offered if Metformin has been unsuccessful.

Another potential benefit of Ozempic over Metformin is that it is administered weekly, so it might be preferable for those who do not wish to take daily medications.

Evidence supports the use of Metformin in pregnancy for treatment of those with type 2 diabetes.