With hope and fear, women turn to weight-loss drugs before pregnancy
Anna Parker found the image online: a teal onesie with a handwritten note on the front. “One day,” it said.
It was a word Mrs. Parker kept repeating to herself. She and her husband have been trying to have a second child for four years and are now undergoing in vitro fertilization. She posted the photo on her Facebook page in January, along with a message about her weight, the highest weight since her first pregnancy. Her blood sugar levels were also disturbingly high.
“I’m scared of getting pregnant,” she wrote in the Facebook post. “I’m so afraid that I will have a miscarriage due to unhealthy living.”
Ms. Parker, 38, wrote in the post that she had just started taking a new diabetes drug, Mounjaro, which is also widely used for weight loss. She felt “miserable” after her first few doses, Ms. Parker said in an interview. She was recently cleaning out her 5-year-old son’s lunchbox, and the smell of ketchup from his dinosaur-shaped chicken nuggets made her throw up in the sink.
Doctors say they are seeing more and more women like Ms. Parker trying weight-loss medications in hopes of having a healthy pregnancy, or getting pregnant at all. Obese women are sometimes advised to lose weight before pregnancy, as research shows that excess weight can make it more difficult to conceive and increase the risk of miscarriage and pregnancy complications.
For patients taking these medications, the side effects are just one challenge. What some say they find more alarming is how little information there is about the risks of taking these medications before or during pregnancy. Because there is virtually no data on Mounjaro, Ozempic, and similar medications during pregnancy, doctors typically recommend women stop taking them at least two months before trying to conceive.
This leaves women with a narrow window: stay on the drugs long enough to see results, but not so long that they could endanger a fetus.
For “a journey as unpredictable and individualized as fertility,” that can be extremely difficult to navigate, said Dr. Akua Nuako, a physician at Massachusetts General Hospital who focused on anti-obesity and weight-loss medications.
Navigating new unknowns
Although some patients hope that these medications can help them become pregnant, they do unclear but whether weight loss always makes it easier to get pregnant. In theory, the body ovulates most regularly and reliably when a person is not overweight or underweight, says Dr. Jessica Chan, a reproductive endocrinologist at Cedars-Sinai.
That’s one reason fertility doctors and clinics sometimes advise patients to lose weight. Some clinics won’t even treat patients with a body mass index of more than 40. Weight-loss medications can be a valuable tool especially for these patients, fertility doctors say. Researchers are also investigating whether these drugs can help women with polycystic ovary syndrome, a leading cause of infertility that leads to irregular periods and is more common in obese women.
“I advise patients, especially if they are not using birth control, that weight loss, especially if there is a significant amount of weight loss, can improve ovulation,” says Dr. Sarah Lassey, physician of maternal fetal medicine at Brigham and Women’s Hospital. . She said she has consulted with more than 100 patients who are taking weight-loss medications and trying to plan a pregnancy.
Part of the appeal to patients like Ms. Parker is the speed at which these drugs can work. For women aged 35 and over, who already have a greater chance of becoming pregnant, that promise can be particularly attractive.
“My husband and I are not getting any younger,” Mrs. Parker said. “So I have to do this quickly.”
And there are the risks of what Ms. Parker sees as an alternative: starting a pregnancy with excess weight or high blood sugar.
While many miscarriages are the result of… chromosomal abnormalitieswomen with uncontrolled diabetes are at higher risk miscarriage. They also develop more often preeclampsia or has a premature birth. The American College of Obstetricians and Gynecologists recommends that providers encourage obese women to lose weight before pregnancy. Studies have suggested a link between obesity and an increased risk of birth defects, stillbirth, premature birth and other concerns, said Dr. Andrea Shields, the vice chair of the organization’s clinical guidelines committee for obstetric care.
It is not clear whether obesity directly causes these problems, or whether other lifestyle factors or health problems, such as diabetes, may play a role.
The conversation around weight, fertility and pregnancy is “already complicated and stigmatized,” says Dr. Nuako, the physician at Massachusetts General Hospital. These medications, she said, only add “an extra level of difficulty.”
‘Holding Our Breath’
When a nurse prescribed Mounjaro to Marcela Romero in November 2022 to lower her blood sugar levels, she balked at the idea of taking a “diet pill,” she said. But Ms. Romero had been trying to get pregnant for three years. She was planning to start in vitro fertilization and was concerned about her weight and risk of gestational diabetes.
At Mounjaro, she stopped thinking about food, lost five pounds in a month and saw her blood sugar levels drop. But she also felt a change in her body that she couldn’t place. Hours after injecting her fourth weekly dose, she took a pregnancy test. When two pink lines appeared, she ran down the stairs of her home in Fort Myers, Florida, and held it up to her father, who was visiting from Colombia. He started crying on the spot.
Ms. Romero was excited but also terrified that she had taken Mounjaro while pregnant. “My first thought was, this is great and all, but do we know if there are any complications during pregnancy? Are there defects that children are born with?” she said. She immediately stopped taking the drug.
She tried not to worry. But she couldn’t shake the fear and found little to ease her worries.
“Obviously there’s no information because it’s so new,” she said.
As in many clinical trials, studies of these drugs excluded women who were pregnant. The companies that make these drugs have said they plan to monitor pregnancy outcomes. One of the few human studies so far, it has been found that women with type 2 diabetes who took these drugs when they became pregnant or during early pregnancy were at no greater risk of having babies with serious birth defects than those who took insulin.
But animal studies have suggested that the drugs can harm a fetus. This is especially concerning if people use the drugs without realizing they are pregnant. And experts also noted that some of these drugs – particularly Mounjaro and the weight-loss drug Zepbound, which contain the same substance – can also make the birth control pill less effective at certain points. in the dosing schedule.
Until more human research comes along, Dr. Shields said, “we’re all just holding our breath.”
Ms. Parker plans to stay at Mounjaro long enough to lose 40 pounds, she said, and then undergo the embryo implantation. Still, she worries about the possible long-term effects of the medication on her body. “It’s a little concerning,” she said. “You think, ‘Is this just the 90s, where we take diet pills that you get at the gas station?'”
Some doctors also said they were concerned about what might happen in the period between patients stopping these drugs and becoming pregnant. Patients often regain weight after stopping the medications and may eventually enter a weight cycle, a term doctors use for weight fluctuations can strain the cardiovascular system.
For patients, every choice during pregnancy can feel like a risk. Mrs. Romero felt like she had reached a point where she could no longer physically control all her worries. “I thought, I’m going to trust the universe,” she said. “It is what it is. Because right now there’s nothing I can do, right?”
In September she gave birth to a healthy baby girl.
Ms. Parker sometimes finds herself searching Facebook posts of other women who have become pregnant after taking these medications. With so little data to look at, all she has are these anecdotes. “Maybe the weight loss outweighs the downsides,” she said. “But I don’t know if we know the disadvantages yet.”