Camille Powe, MD, discusses weight gain from stopping GLP-1RAs in pregnancy

This interview with Camille Powe, MD, endocrinologist at Mass General Brigham, explores new research examining how discontinuing GLP-1 receptor agonists (GLP-1RAs) before or during pregnancy affects gestational weight gain and pregnancy outcomes.

GLP-1RAs—widely used for weight management, glycemic control, and cardiovascular risk reduction—are currently not recommended during pregnancy because of limited human data and concerning animal findings. As a result, patients planning pregnancy or who become pregnant are advised to stop these therapies. Powe and her team sought to understand the consequences of this discontinuation.

In their study, researchers matched pregnant individuals based on pre-pregnancy weight and other relevant characteristics to compare outcomes between those who had recently stopped GLP-1RAs and those who had never used them. They found that individuals who discontinued GLP-1RAs gained significantly more weight during pregnancy than matched controls. This higher gestational weight gain raised concerns because excessive weight gain in pregnancy is linked to complications such as higher infant birth weight and increased obstetric risk.

However, Powe reports that the study produced reassuring findings regarding fetal size: although birth weights were slightly greater among former GLP-1RA users, there was no increased risk of infants being large for gestational age defined as above the 90th percentile—a key risk factor for delivery complications. This suggests that excess maternal weight gain did not translate into substantial increases in fetal overgrowth.

More concerning were the maternal outcomes. The study identified greater rates of gestational diabetes, hypertensive disorders of pregnancy, and preterm birth among individuals who had stopped GLP-1RAs. Powe notes that these risks may reflect the metabolic deterioration—such as weight regain and rising blood glucose—that often occurs when GLP-1 therapy is discontinued.

Regarding clinical management, Powe emphasizes the importance of recognizing that patients with a given body mass index may experience different risks depending on prior GLP-1RA use. Standard approaches—including medical nutrition therapy and physical activity—remain important for moderating gestational weight gain. However, she highlights the need for further research to identify effective medication-based strategies and to better understand the safety of GLP-1RAs during pregnancy.

Ultimately, she underscores the necessity of including pregnant individuals in clinical research to generate evidence that supports safe and effective management for those who discontinue GLP-1 therapy when planning or entering pregnancy.