ACOG GLP-1 guidance advises against these medicines during pregnancy. Breastfeeding is a separate decision, with clear limits for newborn and premature babies. The new guidance leaves room for a conversation with a clinician; it doesn't establish that GLP-1 use while nursing is safe.
As of October 29, 2026, the day this article was written, the American College of Obstetricians and Gynecologists (ACOG) has released guidance on October 23. It covers pregnancy planning, pregnancy itself and lactation, meaning milk production and breastfeeding. GLP-1 medicines act on a gut-hormone signal that helps control appetite and blood sugar.
What the ACOG GLP-1 guidance changes
The October Practice Advisory separates three situations that often get bundled together. Planning pregnancy calls for a stopping plan. Pregnancy calls for advice against continued use. Breastfeeding can involve an individual decision, except that ACOG recommends against use with premature babies and newborns.
In its release, ACOG's lead author says as many as 1 in 300 women are exposed before pregnancy. That is a description of exposure, not a baby's risk of harm.
When to stop a GLP-1 before pregnancy
ACOG says clinicians should explain the limited safety evidence and advise patients to “consider discontinuation 1–2 months before conception.” Conception means becoming pregnant. That class-wide wording doesn't replace a medicine's more specific label.
As of October 29, 2026, the day this article was written, the DailyMed prescribing information carries these revision lines and instructions:
| Source | Exact revision line | Pregnancy-planning wording in section 8.3 |
|---|---|---|
| Wegovy | Revised: 6/2026 | “discontinue WEGOVY in patients at least 2 months before they plan to become pregnant” |
| Ozempic | Revised: 5/2026 | “Discontinue OZEMPIC in women at least 2 months before a planned pregnancy” |
| Zepbound | Revised: 8/2026 | No fixed interval stated |
| Mounjaro | Revised: 8/2026 | No fixed interval stated |
Wegovy and Ozempic contain semaglutide. ACOG's range therefore doesn't shorten semaglutide's two-month label instruction. The clinician plans the transition, including replacement treatment when diabetes needs ongoing care.
Birth control is part of the plan
ACOG notes that GLP-1 weight loss may improve fertility, and says patients who can become pregnant “should be counseled regarding effective contraception while using these medications.” Our semaglutide and PCOS guide explains the fertility evidence. PCOS is a hormone condition that can disrupt periods; returning periods don't establish pregnancy safety.
Tirzepatide, the medicine in Zepbound and Mounjaro, has an additional issue. It slows stomach emptying, which can affect birth-control pill absorption. Both labels' section 7.2 advises switching to a non-oral method or adding a barrier method, such as condoms. Their exact timing phrases are:
- Zepbound: “for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation.”
- Mounjaro: “for 4 weeks after initiation and for 4 weeks after each dose escalation with MOUNJARO.”
Dose escalation means a dose increase. Those are label instructions for a prescriber to discuss, not a precaution automatically shared by every GLP-1 medicine.
What an unplanned pregnancy means
An early exposure doesn't establish that a baby has been harmed. In Cesta and colleagues' 2024 JAMA Internal Medicine study, GLP-1 exposure around conception wasn't associated with a large increase in major birth defects compared with insulin, a hormone used to manage blood sugar. The study involved people with type 2 diabetes and needs confirmation.
ACOG says clinicians should “advise against” use “for the duration of the pregnancy” if conception occurs during treatment. Its pregnancy recommendation has an exception for a clinical trial.
The labels retain different wording in section 8.1:
The Wegovy label (for weight reduction) and the Zepbound label say to stop when pregnancy is recognized. The Ozempic and Mounjaro labels say to use them in pregnancy only if the potential benefit justifies the potential risk to the fetus, and Wegovy uses that wording for MASH with advanced liver scarring. ACOG's advice against use applies across the class either way.
The different wording doesn't remove ACOG's recommendation. It explains why the treatment's purpose matters to the pregnancy-care team. Tirzepatide and pregnancy covers its evidence and labeling in more detail.
GLP-1 breastfeeding guidance: a possible care plan
ACOG says clinicians “may engage” breastfeeding patients in shared decision-making: patient and clinician weigh benefits, unknowns and preferences together. That wording allows a possible postpartum plan, meaning care after birth. It isn't a recommendation for everyone to restart treatment.
ACOG says clinicians “should recommend against” use when nursing preterm infants, meaning babies born early, and neonates, meaning newborns. Its release specifies the “first 28 days of life”. If treatment is used, “close surveillance” of infant weight gain with the baby's clinician “is recommended”.
ACOG also advises avoiding oral GLP-1 medicines during breastfeeding because safety information about changes made to improve absorption is missing. It favors considering shorter half-lives when a medicine is indicated. Half-life means the time it takes the level in the blood to fall by half.
The labels' section 8.2 adds distinctions:
| Label | Breastfeeding wording and limits |
|---|---|
| Wegovy injection and Ozempic | Weigh breastfeeding benefits, the mother's clinical need and possible infant effects; the labels state that human-milk, infant-effect and milk-production data are unavailable. |
| Wegovy tablets | Breastfeeding isn't recommended because an absorption aid called SNAC may accumulate in the infant. |
| Zepbound and Mounjaro | Describe low or undetectable milk levels after a single dose; effects on infants and milk production remain unknown. |
Those label statements don't replace ACOG's newborn and premature-infant recommendation. The semaglutide and pregnancy guide covers semaglutide's specific breastfeeding study and its limits.
What this means for compounded prescriptions
Semaglutide and tirzepatide prescribed through Promise are prepared and dispensed by a licensed U.S. compounding pharmacy as compounded medications for individual prescriptions. Each is different from an FDA-approved product: the formulations offered here are not FDA-approved. The FDA's compounding Q&A, current as of September 16, 2025, explains that these preparations aren't reviewed for safety, effectiveness or quality before marketing.
A licensed provider may still prescribe — that decision is between you and your doctor. That regulatory fact doesn't change the pregnancy and breastfeeding recommendations above. At Promise, a licensed provider reviews every request, and not everyone qualifies.
What to watch next
ACOG calls for research on milk volume, milk composition, infant growth and long-term safety. Low drug levels in milk cannot answer whether reduced appetite changes a parent's nutrition or milk supply.
Follow-up after stopping matters too. Maya and colleagues' 2025 JAMA study associated GLP-1 use followed by discontinuation with greater pregnancy weight gain and some pregnancy complications. It was observational: it followed existing care rather than assigning treatment, so it cannot prove that stopping caused those outcomes.
ACOG says clinicians “should encourage” nutrition, activity and weight monitoring after discontinuation and during and after pregnancy. ACOG says it will monitor emerging evidence and update its guidance as needed.
