Weight loss injections and pregnancy: A danger for the child?

interview

Recently, we’ve heard of “Ozempic babies” in the USA: these are children of women who unexpectedly became pregnant after taking the weight-loss injection containing the active ingredient semaglutide. The drug is not approved for pregnant women. Have you already received worried calls in your practice in Ulm?
Yes, we have been contacted about this for about a year now, and I know of around 20 cases in total. I remember a patient who noticed she was pregnant in the eighth week. Her cycle was very irregular, and missing her period was not unusual for her. A short time later she lost the child. There could be many reasons for this and it probably has nothing to do with the medication. Another woman in her forties had long since finished planning her family. She only noticed she was pregnant after more than 20 weeks. The child was born healthy and happy.

What do you say to women when you receive inquiring calls?
I refer to the animal experiments and the data on pregnant women, which is unfortunately very limited. We know from the animal experiments that semaglutide in the dose that we use for humans has no effect on the offspring. Only at five times the amount was the metabolism of the mother animals disrupted, so that fetuses were no longer properly nourished. For example, skeletal development was delayed. At three times the dose, the abortion rate was (Miscarriage rate, editor’s note) increased and the offspring were born with a little less weight than usual. But we cannot transfer animal data 1:1 to humans. Just because animal tests are unremarkable, a drug would not be used generously on pregnant women.

What does this mean for women?
I advise every woman who wants to have children not to use semaglutide to lose weight. We do not know exactly how the drug affects the unborn child. If someone accidentally becomes pregnant with semaglutide, this is not a reason to terminate the pregnancy.

What scientific experience is there with pregnant women?
Few. Last autumn, the woman suffered from PCOS, was overweight and had an irregular cycle. She lost 27 kilos with semaglutide. She was in the fourth week when she realized she was pregnant and stopped taking the medication. The child was born healthy. The data from five counseling centers like ours were evaluated. There, the rate of serious birth defects in children of 168 women who had become pregnant while taking weight-loss drugs like Ozempic was the same as in women with type 2 diabetes or obesity.

In your opinion, what would be a safe way for women to take advantage of the opportunities offered by weight loss injections?
The therapy could be prescribed until they have regular ovulation and cycles. In most cases, losing 10 to 15 kilos is enough to achieve this. Due to the half-life of one week, there should be at least five weeks between the end of the therapy and conception. Conversely, a woman who takes Ozempic or a similar drug and does not want to have children must use thorough contraception!

Is the topic now being discussed more frequently at specialist conferences?
There is a lot of talk about it in fertility centers – especially because patients ask about it. Semaglutide is used there if women do not lose weight despite other treatment attempts. But it is not yet an issue in general. I do a lot of prenatal diagnostics, so most of my colleagues do not know what possible malformations they should look out for in an Ozempic baby.

There will be no studies with pregnant women due to possible risks for mother and child. To be completely certain, we need registry data containing information from everyday treatment.
Yes, but we can wait a long time in Germany because we don’t have systematic registers! Scandinavia and the USA in particular are way ahead of us. There, all diagnoses, therapies, events during a pregnancy and the child’s health data are systematically recorded. Depending on the question, the relevant figures can easily be obtained from the databases. The only malformation monitoring system in Germany dates back to the GDR era in Saxony-Anhalt. Only two to three percent of births in this country are reported to the European Surveillance of Congenital Anomalies.

This means we have to wait for the data from the other countries. How much do we need and how quickly could there be an initial evaluation?
In order to be meaningful, there should be at least 300 women who became pregnant while taking the drug in question. The cases should be followed prospectively. This means that pregnancies should be registered immediately and not only when the child is born with an abnormality. That would falsify the data. I hope that we can expect further studies soon. But until we have anything in hand, we advise women: Please do not become pregnant while taking the weight loss injection.

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