Semaglutide (Ozempic®, Rybelsus®, Wegovy®)
Information last updated November 2024
Most pregnancies result in healthy babies, but there are chances of complications and unexpected outcomes. These chances are called baseline risks. In Canada, the baseline risk of major birth defects is 3-5%. This means that 3-5 out of 100 babies born in the general population will be born with a major birth defect. There are also baseline risks for miscarriages (15-25 out of 100 pregnancies), premature birth and other outcomes. The information provided will summarize if taking this drug is likely to change these risks.
Summary:
Semaglutide belongs to a family of medications called Glucagon-Like Peptide-1 Receptor Agonist (GLP1-RA). There are no studies specifically on semaglutide, but there are studies including over 600 pregnancies where a GLP1-RA was used during the first trimester. These studies found no increased risk of major birth defects when GLP1-RAs were used during the first trimester.
The data on safety of semaglutide is still emerging and although the currently available information on GLP1-RAs as a group is reassuring, there is not enough evidence yet to fully understand the risks and benefits of using semaglutide during pregnancy. If pregnancy occurs while taking semaglutide, the medication should be stopped. It is recommended to stop semaglutide two months before a planned pregnancy.
Stopping semaglutide without an alternative treatment plan may lead to worsening control of diabetes and/or excessive weight gain, which are associated with pregnancy complications. Speak to your healthcare provider about how to stop semaglutide safely and for advice on other treatment options, if needed.
To see more details please click on the tabs below.
Please consult with your health care provider if you are considering stopping or making any changes to your regular medications.
This information about semaglutide is of a general nature and about medical use and does not replace the medical care and advice of your healthcare provider. For questions on dose, timing, side effects, interactions, etc. please consult your healthcare provider. Additionally, please read the patient insert provided with your medication.
Semaglutide (Ozempic®, Wegovy®, Rybelsus®) is a Glucagon-Like Peptide-1 Receptor Agonist (GLP1-RA) used to treat type 2 diabetes mellitus (Ozempic®, Rybelsus®) and for long-term weight management (Wegovy®).
If the product you are using contains other active ingredients, please check our Exposures A to Z for available information on the ingredient(s).
For more information on GLP1RAs while pregnant or while providing your breastmilk to an infant, please see GLP1-RAs: The New Era of Diabetes and Weight Loss Management, FAQs in Pregnancy and Lactation
Pronunciation
The available information on use of GLP1-RAs during pregnancy is reassuring. As currently, we do not have enough information on safety of semaglutide use in pregnancy it is recommended to stop it 2 months before pregnancy. Based on its properties it should take about 5 weeks for semaglutide to be cleared from the body.
Approximately 1000 pregnancies where women received a GLP1-RA in the 12 weeks before becoming pregnant or in the first trimester were included in studies. No increased risk of birth defects was found when these pregnancies were compared to pregnancies of women with similar medical conditions, who did not use a GLP1-RA. No increased risk of birth defects was found when evaluating the over 600 pregnancies exposed to a GLP1-RA in the first trimester.
This information is reassuring for individuals who are exposed when they did not know they were pregnant.
If you are taking medications and you notice any new health concerns or symptoms in your nursing infant, please contact their health care provider. In case of emergency, please go to the emergency room or call 911.
If you are taking a medication or substance while providing your breastmilk to an infant, you need to know how much of the medication or substance is passing into your milk. One of the commonly used measurements to estimate this is the Relative Infant Dose (RID). The RID is estimated by comparing the dose of drug taken in by the infant through breastmilk to the dose that the nursing parent takes. Most medications with an RID of less than 10% are usually compatible with nursing a healthy infant. The RID does not need to be calculated for each person because most of the time it is expected to be similar to what has been found in research studies. We will provide the RID in the information below, when available.
Based on the properties of semaglutide, it is not expected to pass into breastmilk in large amounts.
Semaglutide was not found in the breastmilk of 8 women who were treated with 0.25 to 1mg of subcutaneous semaglutide per week. No side effects related to semaglutide were reported in their children.
No studies have been done to see if semaglutide use affects breast milk supply. Until more information is available, an alternative treatment may be preferred.
In the oral tablet, Rybelsus®, semaglutide is combined with another ingredient that is known to pass into breastmilk in low amounts. As the safety of this ingredient is not known, Rybelsus® should be avoided by those providing their breastmilk to an infant.
Medications, if not taken as prescribed, if taken beyond the prescribed amount, or if taken in combination with certain other drugs, may cause harm to you and/or your pregnancy or your nursing child.
If you are using drugs or medications for non-medical reasons or beyond what was recommended by a healthcare practitioner and you are pregnant, providing your breastmilk to an infant, or parenting please click Harm Reduction for additional information. In case of emergency, please go to the emergency room or call 911.
Pre-Pregnancy:
Semaglutide has a half-life of approximately seven days. Therefore, it should be cleared from the body in about five weeks. Although the evidence to date is largely reassuring, due to the limited information on exposure to semaglutide during pregnancy the current recommendation is to stop it two months before pregnancy. In the event of unexpected exposure, the evidence to date has not shown evidence of harm.
Pregnancy:
Approximately 1000 pregnancies where the women received a GLP1-RA within the 12 weeks before conception or in the first trimester were included in studies. No increased risk of birth defects was found when these pregnancies were compared to pregnancies of women with similar medical conditions, who did not use a GLP1-RA. When limiting the analysis to pregnancies exposed in the first trimester (approximately 600), no increased risk of birth defects was observed.
This information is reassuring for those with inadvertent exposures during pregnancy.
Studies examined the association between other outcomes and exposure to a GLP1-RA in approximately 200 pregnancies. No association was found with miscarriage, stillbirth, prematurity, or low birth weight. More data are needed to confirm that there are no increased risks of these outcomes.
Paternal exposure:
There is one study showing improvement in sperm morphology, and in testosterone levels following semaglutide treatment in 13 men with obesity, functional hypogonadism and type 2 diabetes. This study is too small to draw any conclusions on the effect semaglutide may have on fertility in men.
Lactation:
One of the factors that helps to determine if a medication is compatible with nursing is the Relative Infant Dose (RID). The RID provides an estimate of infant’s exposure to a medication through breastmilk. It is the ratio between the infant’s and the nursing individual’s weight-adjusted doses. The infant weight adjusted dose is estimated based on the concentration of medication in breastmilk, and an assumption of infant daily milk consumption of 150 ml/kg/day. In general, for infants with normal growth and development, most medications with an RID of less than 10% are considered compatible with nursing. The RID does not account for infant’s drug metabolism, clearance, or infant blood levels. Although some variability may exist in the RID, in most cases the estimated RID is adequate for clinical purposes and does not need to be calculated for each individual. We will provide the RID in the information below, when available.
Semaglutide is >99% protein bound and has a large molecule weight (4113.6 Dalton) which makes it unlikely to transfer into breastmilk in large quantities. Semaglutide is protein molecule and any ingested drug will likely be degraded by enzymes in the infant stomach.
A study examined semaglutide concentrations in breastmilk samples from 8 women treated with 0.25 to 1mg of subcutaneous semaglutide per week. No semaglutide was detected. No side effects attributed to semaglutide were reported in their children.
No studies have been done to see if semaglutide use affects breastmilk supply. Until more information is available an alternative treatment may be preferred.
In Rybelsus® (oral formulation) semaglutide is combined with salcaprozate sodium (SNAC), to increase absorption. SNAC and some of its metabolites are excreted into breastmilk in low amounts. However, information on their safety during lactation is lacking. Until more data are available Rybelsus® should be avoided by those providing their breastmilk to an infant.
Harm Reduction:
If your patient may be using drugs or medications not as indicated during pregnancy, while providing breastmilk to an infant, or parenting please click Harm Reduction for additional information. In case of emergency, please advise them to go to the emergency room or call 911.
For additional resources see Health Canada Drug and Natural Health Product Monographs, Making Sense of Risk and Statistics.
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Dao K, Shechtman S, Weber-Schoendorfer C, Diav-Citrin O, Murad RH, Berlin M, et al. Use of GLP1 receptor agonists in early pregnancy and reproductive safety: a multicentre, observational, prospective cohort study based on the databases of six Teratology Information Services. BMJ Open. 2024;14(4):e083550. [PMID: 38663923]. [PMC11043712].
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Novo Nordisk Canada. Ozempic® semaglutide injection Product Monograph 2018 [Revised January 29, 2025] [updated January 25, 2025; cited 2025 July 10]. Available from: https://pdf.hres.ca/dpd_pm/00078459.PDF.
Novo Nordisk Canada Medical Information Department. Ozempic® (semaglutide) injection – Pregnancy, Fertility and Breastfeeding Product Monograph [Personal Communication]. Mississauga ON: Novo Nordisk Canada; 2025.
Novo Nordisk Canada. RYBELSUS® semaglutide tablets Product Monograph Mississauga ON: Novo Nordisk Canada; 2020 [Revised date January 22, 2025] [updated January 22, 2025; cited 2025 July 10]. Available from: https://pdf.hres.ca/dpd_pm/00078364.PDF.
Novo Nordisk Canada Medical Information Department. Rybelsus® (semaglutide) tablets and Fertility, Pregnancy, and Lactation Product Monograph [Personal Communication]. Mississauga, ON: Novo Nordisk; 2025.
Novo Nordisk Canada Medical Information Department. Ozempic® (semaglutide) injection – Pregnancy, Fertility and Breastfeeding Product Monograph [Personal Communication]. Mississauga ON: Novo Nordisk Canada; 2025.
Public Health Agency of Canada. Congenital Anomalies in Canada 2013: A Perinatal Health Surveillance Report. [Internet]. Ottawa: Public Health Agency of Canada; 2013 [updated 2013 September; cited 2023 September 8]. Available from: https://publications.gc.ca/collections/collection_2014/aspc-phac/HP35-40-2013-eng.pdf
Public Health Agency of Canada. Family-centred maternity and newborn care: National guidelines Chapter 7: Loss and grief. [Internet]. Ottawa: Public Health Agency of Canada; 2022 [updated 2022 Aug 10; cited 2023 September 9]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-7.html
Roberts K, Bazzetta SE, Eivazi M, Boots CE. Glucagon-Like Peptide 1 (Glp-1) Agonists during Oocyte and Embryo Cryopreservation. Fertility and Sterility. 2024;122(4 Supplement):e249. [PMID: 2035186002].
Sanusi A, Xue Y, Jauk VC, Ugwu L, McCarley CB, Tilton A, et al. Association of Glucagon Like Peptide-1 Agonist (GLP1) use With Pregnancy Outcomes [Poster Session 3 – Abstract 710 – Society for Maternal-Fetal Medicine Annual Pregnancy Meeting] Pregnancy. 2025;1(S1):e12028. [PMID N/A].
Skov K, Mandic IN, Nyborg KM. Semaglutide and pregnancy. Int J Gynaecol Obstet. 2023;163(2):699-700. [PMID: 37688299].
U.S. Food and Drug Administration – Center for Drug Evaluation and Research. Wegovy (Semaglutide) Injection Subcutaneous – Patient Labelling Review – Application Number 215256Orig1s000 SEE Division of Pediatric and Maternal Health Review Section. Washington DC: U.S. Food and Drug Administration; 2021 [cited 2025 July 10]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2021/215256Orig1s000OtherR.pdf
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Disclaimer
First Exposure does not offer health care treatment. If you have an urgent question about your pregnancy or your baby’s health, you should contact your health care provider directly. If you don’t have a health care provider and you live in Ontario, you have a variety of health care options. In the case of an emergency, visit a hospital emergency room or call 911.