Consideration of Use of Semaglutide and Tirzepatide Prior to Pregnancy


  • Alyse Goldberg, MD, FRCPC Division of Endocrinology, University of Toronto, Toronto, Ontario



In reproductive-age females with elevated body mass index (BMI), weight loss is often recommended independent of their reproductive and family planning goals. However, it is clear that lifestyle methods for losing weight often fall short of achieving and maintaining weight loss. As approaches to addressing obesity and weight optimization evolve beyond the simplistic notion of “eat less and move more,” there has been a growing acceptance of weight loss medications as part of comprehensive weight management strategies. It should also be noted that health optimization cannot be solely attributed to reducing BMI or kilograms of body weight. The objective of this paper is not to contribute to the well-established weight stigma in medicine, but rather to highlight a thoughtful approach to the use of weight loss medication in a cohort where the prevalence is expected to rise independent of the indication.

Author Biography

Alyse Goldberg, MD, FRCPC, Division of Endocrinology, University of Toronto, Toronto, Ontario

Dr. Alyse Goldberg practices as a consultant endocrinologist at fertility centres in Toronto, as well as at the Women’s and Babies team at Sunnybrook Health Sciences Centre managing patients with gestational diabetes. She is a member of the International PCOS Network that authored the 2023 International Evidence-based Guidelines for Assessment and Management of PCOS. She focuses on care of patients with polycystic ovarian syndrome, as well as pregestational metabolic optimization.


Creanga AA, Catalano PM, Bateman BT. Obesity in pregnancy. Longo DL, ed. N Engl J Med. 2022;387(3):248259.

Malin SK, Kashyap SR. Effects of metformin on weight loss: potential mechanisms. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):323-9.

Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023;189(2):G43-G64.

Zhao Q, He J. Efficacy and safety of metformin in pregnant women with polycystic ovary syndrome: a systematic review with meta-analysis of randomized and non-randomized controlled trials. Gynecol Endocrinol. 2022;38(7):558-68.

Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002.

Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-16.

MOUNJARO (tirzepatide) injection for subcutaneous use. Highlight of Prescribing Information. Accessed February 24, 2024. https:// www. acces sdata. fda. gov/ drugs atfda_ docs/ label/ 2022/ 21586 6s000 lbl. pdf.

OZEMPIC (Semaglutide) injection, for subcutaneous use. Highlights of Prescribing Information. Accessed February 24, 2024.

Rubino DM, Greenway FL, Khalid U, et al. Effect of weekly subcutaneous semaglutide vs daily liraglutide on body weight in adults with overweight or obesity without diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138.

Goldberg AS, Dolatabadi S, Dutton H, et al. Navigating the role of anti-obesity agents prior to pregnancy: a narrative review. Semin Reprod Med. 2023;41(3-04):108-18.

Espinós JJ, Solà I, Valli C, et al. The Effect of lifestyle intervention on pregnancy and birth outcomes on obese infertile women: a systematic review and meta-analysis. Int J Fertil Steril. 2020;14(1).

Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-25.

Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38.

Skov K, Mandic IN, Nyborg KM. Semaglutide and pregnancy. Int J Gynecol Obstet. 2023;163(2):699-700. doi:10.1002/ijgo.15092

Carey KJ, Vitek W. Weight cycling in women: adaptation or risk? Semin Reprod Med. 2022;40(05/06):277-82.

Joshi GP, Abdelmalak BB, Weigel WA, et al. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. Published June 29, 2023. Accessed July 2, 2023.

Muller DRP, Stenvers DJ, Malekzadeh A, et al. Effects of GLP-1 agonists and SGLT2 inhibitors during pregnancy and lactation on offspring outcomes: a systematic review of the evidence. Front Endocrinol. 2023;14:1215356.

Cesta CE, Rotem R, Bateman BT, et al. Safety of GLP-1 receptor agonists and other second-line antidiabetics in early pregnancy. JAMA Intern Med. 2024;184(2):144.

Jensterle M, Ferjan S, Goricar K, et al. The maintenance of long-term weight loss after semaglutide withdrawal in obese women with PCOS treated with metformin: A 2-year observational study. Accessed February 6, 2024.,kg%2C%20P%3D0.001).




How to Cite

Goldberg, A. (2024). Consideration of Use of Semaglutide and Tirzepatide Prior to Pregnancy. Canadian Women’s Health Today, 1(2), 5–9.