Breastfeeding And GLP-1s

Check out the full study here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11397063/

Diab H, Fuquay T, Datta P, Bickel U, Thompson J, Krutsch K. Subcutaneous Semaglutide during Breastfeeding: Infant Safety Regarding Drug Transfer into Human Milk. Nutrients. 2024 Aug 28;16(17):2886. doi: 10.3390/nu16172886. PMID: 39275201; PMCID: PMC11397063.

What happens when cutting-edge metabolic care meets the realities of breastfeeding? We take a clear-eyed look at a small but important study on semaglutide that found no detectable levels of the medication in breast milk from eight mothers, and we translate the data into practical guidance you can use. Beyond the lab results, we get real about the trade-offs: how appetite suppression can quietly undermine maternal nutrition, milk supply, and infant growth if the plan isn’t carefully managed.

We walk through the study’s methods and why the relative infant dose estimate of 1.26% sits well below commonly accepted safety thresholds, while also calling out the study’s limits: small sample size, only semaglutide tested, and no direct data on higher doses or tirzepatide. Then we zoom out to the bigger picture. Postpartum women managing type 2 diabetes or obesity need tools that stabilize glucose, protect cardiometabolic health, and support sustainable energy—without compromising a baby’s nutritional needs. That balance is possible with intentional choices.

You’ll hear a practical framework for decision-making: consider a lower restart dose, build a tight care team (pediatrician, dietitian, obesity medicine physician, OBGYN or family doctor), monitor infant growth and maternal intake, and track markers like A1C, weight trends, and symptoms of under-fueling. We highlight nutrient priorities for lactation—protein, iron, iodine, choline, DHA, calcium, and overall calories—and we share signs it’s time to adjust the plan, from fatigue and hair loss to decreased milk supply.

The takeaway is nuanced but hopeful. The absence of detectable semaglutide in milk reduces one major concern, yet responsible care still hinges on nutrition, dose, and close monitoring. If you’re navigating GLP-1 therapy while breastfeeding or planning a pregnancy, this conversation equips you to ask sharper questions and collaborate with your clinicians on a plan that protects both mom and baby. If this resonated, subscribe, leave a review, and share the episode with someone who needs a balanced, evidence-informed perspective.

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Episode Transcript

Speaker (00:00):
Welcome to the Modern Metabolic Health Podcast with
your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.

(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
For women who are on a GLP1medication for type 2 diabetes

(00:49):
or the disease of obesity, thecurrent recommendation is to
stop the GLP 1 medication inpreparation for a pregnancy if
it's a planned pregnancy, or tostop the medication once you
find out that you're pregnant,and then not to start until you
are done breastfeeding.
This recommendation is made outof an abundance of caution and

(01:13):
because we lack quality studiesand real-world long-term
evidence of the safety of theseremarkable medications.
But for any woman who has beenon a GLP1 medication and
experienced the many benefits ofthis treatment, they are very
anxious to restart theirmedication after pregnancy.

(01:38):
The good news is that there hasbeen a recent study that gave
really great informationspecifically about semaglutide
and whether or not that isexpressed in the breast milk for
women who are stillbreastfeeding.
Today we're gonna talk aboutthat study and what it means for

(02:01):
women who are planningpregnancies and are on a GLP1
medication.
As mentioned in the intro, I ama physician and I'm sharing
general medical knowledge.
This is not direct medicaladvice, and this is something
that you should take back toyour doctor to have the

(02:22):
individualized advice that isbest for you.
This is not medical advice,just general medical knowledge.
So the study that we're talkingabout today will be linked
below, and it is free to accessso you can read it all on your
own.
We're gonna go over the bigtakeaways together.
So this study looked at eightindividual women who were on a

(02:48):
GLP 1 medication.
They had a baby recently andwere breastfeeding, and they
restarted their GLP1 medication.
All of them were at least sixmonths postpartum, and they took
it for at least three weeks toget the medication back into
their system.
So then the researchers tooktheir breast milk at the same

(03:12):
time they did their GLP1, theirsemaglutide injection.
They also took a sample 12hours later, and then again 24
hours later to test for thepresence of semaglutide.

And just a reminder (03:25):
the brand names of semaglutide are Ozempic
and Wigovi.
So this study was specific tothose medications.
They did not test fortrazepitide brand names Zeppound
and Monjaro.
And very perhaps surprisingly,they did not find any detectable

(03:46):
levels of semaglutide in thebreast milk of these women.
Now, this is really excitingnews because it opens the door
for further studies.
Again, this was only eightwomen, so it doesn't represent
the entire population, but it'svery, very promising that GLP1

(04:08):
medications, specificallysemaglutide, are likely safe
during breastfeeding.
Specifically, that they are nottransferred from the woman's
body to baby because there areundetectable levels in breast
milk.
What was really great thatthese researchers did was they

(04:28):
utilized an equation which wasfairly complicated, but it was
able to even estimate like aworst-case scenario possibility
if some of that medication didget into the breast milk.
And it was a very, very lowquantity.
Again, worst-case scenario thatwould be transferred into the

(04:49):
breast milk that was well belowthe predefined cutoff for safety
in breast milk.
So that estimate is calledrelative infant dose or RID.
And for this study, that wasfound to be 1.26%.
And the safety threshold cutoffis 10%.

(05:11):
It's also important to notethat this study looked at a few
different doses that they lookedat the starting dose is 0.25,
the next dose 0.5, and then 1milligram of semaglutide.
They did not have any testingfor higher doses, but that
estimate did take that intoaccount.
And so they would estimate thatif they did find any of

(05:36):
semaglutide in the breast milkfor women who are on
semaglutide, Wegovy or Ozempic,it would be a very low amount,
but that was not directly testedin this study.
And why further studies arerequired before major societies
like the Endocrine Society isgoing to recommend restarting

(05:58):
GLP1 medications duringbreastfeeding.
Right now, this study is notenough to recommend that it is
safe to restart GLP1 medicationsduring breastfeeding,
especially when looking at abroad population.
But it does open the door for aconversation with your medical
provider.

(06:18):
With anything in medicine, whenwe are determining a treatment,
we are weighing the risks andthe benefits of that treatment.
And specifically forbreastfeeding and for treating
metabolic conditions like type 2diabetes and obesity, we need
to take both things intoaccount.
I say this because we oftenoverestimate the risk of a woman

(06:42):
taking a medication whilebreastfeeding and underestimate
the risk of not treating thatcondition.
So this is a great way to startthat conversation.
And what is your individualrisk?
Because that does vary fromperson to person.
So a few things to think about.
One is that this did not lookat long-term results.

(07:07):
And so that is something thatfurther studies will show.
It also did not look attrusepatide, so we cannot
extrapolate this information toreflect what would happen for
women who are taking Zepbound orMounjaro.
And then another reallyimportant thing is that it did
not have the opportunity to lookat maternal nutrition and what

(07:30):
potentially limiting maternalnutrition via a GLP1 medication
will do for baby's overallhealth and growth trajectory.
This is extremely important toconsider because women who are
breastfeeding are going to needextra nutrients to have the

(07:54):
stores and the energy to passthat on to baby.
So if you are taking amedication that is suppressing
your appetite to the point whereyou're not able to get that
adequate nutrition, then notonly is that going to be
detrimental to your own healthand increase risks like
nutritional deficiencies, hairloss, muscle wasting, it also

(08:19):
will impact baby's nutrition,may slow baby's growth, may um
affect brain development.
It can have a really negativeimpact on baby that we may not
see immediately.
So again, just because we'renot seeing semaglutide
transferred from mom to baby viabreast milk, that does not mean

(08:43):
that taking semaglutide whilebreastfeeding is the best option
for you and baby, because weneed to make sure you are still
optimizing your nutrition.
And this is where utilizing adietitian and working with a
board-certified obesity medicinephysician is crucial.
I do think there is space foruh GLP1 medication, as of right

(09:10):
now, semaglutide duringbreastfeeding, probably at a
lower dose than what you were onbefore, closely monitored with
a dietitian, the pediatrician,obesity medicine physician,
OBGYN, family medicine doctor,your whole team needs to be
aware of what is going on,ensuring that you're getting the
adequate support and nutritionthat you and baby need for

(09:33):
long-term health.
This study, in my opinion, wasextremely important.
It was the start of studyingthe use of GLP1 medications
during breastfeeding.
What we learned is thatsemaglutide is not detected in
breast milk, at least for theseeight women, we need larger
studies to confirm that.
We also need to study what isthe implication of GLP1

(09:58):
medications duringbreastfeeding.
How is that impacting mom andbaby's nutrition?
And how does that impact theirhealth long term?
We do know that breastfeedingis one of the best things that
you can do for your newborn.
So we want to do as much as wecan to encourage that for at
least six to 12 months tooptimize baby's health.

(10:19):
We also know that we need totreat mom's metabolic condition.
So again, we're going back toweighing those risks and
benefits in this situation.
Talk to your doctor, find outwhat is best for you, and
subscribe to this channel sothat you will get ongoing
updates as more research is donein this area because I

(10:40):
anticipate there's going to be alot more research in this area
to better optimize maternal andfetal health.
I hope this was helpful and Ihope you take this information
and share it with somebody whowould benefit a woman who is on
a GLP 1, or maybe a close friendor family member who is on a
GLP 1 and is maybe planning apregnancy in the future.

(11:04):
I'm sure this would be reallygreat information for her to
have.