GLP-1 drugs and pregnancy: Why stopping may trigger hidden risks

As GLP-1 use rises, research and experts warn the post-drug phase may be a critical window for weight gain, metabolic instability and unexpected pregnancies

Weight-loss and diabetes drugs like GLP-1 receptor agonists have transformed how obesity, insulin resistance and PCOS are treated. But as their use rises among women of reproductive age, doctors are confronting a crucial question — what happens when these injections are stopped, especially just before or during pregnancy?

 

A study published in the Journal of the American Medical Association suggests the period after discontinuation may be a critical, and underappreciated, risk window for gestational weight gain and pregnancy complications.

 

GLP-1 pregnancy research: What the JAMA study found

 

The study, ‘Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation’, analysed pregnancy outcomes in women who had previously used GLP-1 drugs and stopped them before conception.

 

Key findings included:

 

• Higher gestational weight gain compared to women with no prior GLP-1 exposure
• Gestational diabetes seen in 20 per cent of GLP-1–exposed women versus 15 per cent in controls
• Preterm delivery rates of 17 per cent compared to 13 per cent
• Hypertensive disorders affecting 46 per cent versus 36 per cent

 

While GLP-1 drugs are not advised for use during pregnancy and were stopped before conception, researchers noted that metabolic changes following withdrawal may still influence outcomes. The findings challenge the assumption that stopping the medication alone is enough to neutralise risk.

 

“This research changes the counselling conversation from ‘stop the medication and proceed’ to ‘stop the medication and prepare for metabolic rebound,’” says Dr Gagandeep Singh, specialist in diabetes, hypertension, obesity, PCOS and founder, Redial Clinic.

 

Metabolic rebound after stopping GLP-1: Why timing matters for pregnancy

 

GLP-1 receptor agonists work by mimicking gut hormones that promote fullness, slow gastric emptying and suppress appetite. When the medication is stopped, these effects wear off quickly.

 

“When that pharmacological brake is removed, appetite signals return almost immediately — often with compensatory intensity,” Dr Singh explains. “Patients describe it as suddenly hearing the noise again after months of quiet.”

 

He stresses that this response is biological, not behavioural. “This isn’t a failure of willpower — it’s physiology.”

 

The impact extends beyond appetite alone. Dr Singh notes that stopping GLP-1 therapy often triggers a broader metabolic reversal. “We don’t just see weight regain. We see insulin sensitivity worsening, HbA1c rising, and improvements in blood pressure and lipid levels unwinding,” he says.

 

Evidence suggests this rebound begins sooner than many expect. Weight regain can start within eight weeks, with the most rapid increase in the first six months. Metabolic markers such as HbA1c may rise by around 0.25 per cent after discontinuation, while cardiovascular benefits can reverse even faster than weight changes.

 

This timing is particularly important for pregnancy. Dr Singh shares that pregnancy naturally induces insulin resistance to prioritise glucose delivery to the foetus. If this occurs when metabolic control is already unsettled after GLP-1 withdrawal, the added strain can increase the risk of gestational diabetes and hypertensive disorders.

 

GLP-1 and fertility: Why some women get pregnant sooner than expected

 

Beyond weight and metabolic risks, doctors are also seeing changes in fertility patterns among women using or stopping GLP-1 drugs. In India, Dr Singh says two distinct trends are emerging in practice.

 

One group includes women with PCOS and insulin resistance who previously struggled with irregular periods or anovulation. As weight reduces and insulin sensitivity improves, ovulation often resumes, sometimes for the first time in years. For these women, pregnancy is expected and often welcomed.

 

The second group is more concerning. Some women assume long-standing infertility will persist and are unprepared for how quickly reproductive function can return. “They’re caught off-guard when cycles normalise and ovulation returns faster than anticipated,” Dr Singh says. With India’s high burden of PCOS and the expanding use of GLP-1 drugs for weight and metabolic health, clinicians expect to see more such cases.

 

This has led to talk of a GLP-1–linked “baby boom”, but Dr Singh believes that framing misses the point.

 

“These drugs aren’t enhancing fertility, they’re removing metabolic barriers to normal reproductive function,” he says.

 

For women using GLP-1 drugs, fertility may return sooner than expected, and careful planning around when and how treatment is stopped can be just as important as the decision to start it.

 

Pregnancy planning after GLP-1: Rethinking weight management after stopping

 

“The idea of stopping GLP-1 drugs two months before conception and hoping for the best is inadequate,” he says.

 

He recommends a structured transition approach:

 

• Build strong nutrition and exercise habits before stopping medication
• Closely monitor weight and metabolic markers during withdrawal
• Aim for at least two to three months of weight stability before trying to conceive

 

“The goal should be metabolic resilience, not just medication compliance,” he adds.

   

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This report is for informational purposes only and is not a substitute for professional medical advice.