Impact of semaglutide exposure on fetal and neonatal outcomes in pregnant women: a systematic review

Nov 28, 2025European journal of obstetrics, gynecology, and reproductive biology

Semaglutide exposure during pregnancy and its effects on babies before and after birth

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Abstract

Five studies with a total of 1,128 pregnancies exposed to semaglutide showed mixed fetal and neonatal outcomes.

One study reported adverse outcomes, including spontaneous abortion and preeclampsia.
The spontaneous abortion rate associated with semaglutide was 23%, similar to rates in diabetes and obesity groups.
A prevalence of congenital malformations of 8.3% was observed, with no significant risk increase compared to insulin.
Discontinuation of semaglutide was linked to fetal macrosomia and neonatal hypoglycemia.
Preterm birth and large-for-gestational-age infants were noted, but no increased risk of congenital malformations was found.
Current evidence is limited by variability among studies and does not indicate a consistent increased risk of major congenital malformations.

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BACKGROUND: Semaglutide, a glucagon-like peptide-1 receptor agonist, is increasingly used for obesity and type 2 diabetes treatment. As its use rises among women of reproductive age, understanding its impact on fetal and neonatal health is essential.

OBJECTIVES: To assess fetal and neonatal outcomes associated with semaglutide exposure during pregnancy or within two months before conception.

SEARCH STRATEGY: PubMed, Embase, and ClinicalTrials.gov were searched for relevant studies.

SELECTION CRITERIA: Studies reporting fetal and neonatal outcomes following semaglutide exposure before or during pregnancy were included, with no language restrictions.

DATA COLLECTION AND ANALYSIS: Two reviewers independently screened and extracted data. Due to study heterogeneity, a narrative synthesis was used, and bias risk and study quality were assessed.

MAIN RESULTS: Five studies involving a total of 1,128 semaglutide exposed pregnancies, showed mixed results. One study reported adverse outcomes including spontaneous abortion and preeclampsia. Another study found spontaneous abortion rate of 23%, comparable to diabetes- and obesity-groups. A third study observed a prevalence of congenital malformations of 8.3%, with no significant risk increase compared to insulin. One study linked semaglutide discontinuation to fetal macrosomia and neonatal hypoglycaemia. Another noted preterm birth and large-for-gestational-age infants, with no increased congenital malformation risk. No clear association with birth defects was identified, however the evidence is limited by study variability and bias risk.

CONCLUSIONS: The limited number of available studies precludes firm conclusions nevertheless current evidence does not indicate a consistent increased risk of major congenital malformations associated with semaglutide exposure.

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Impact of semaglutide exposure on fetal and neonatal outcomes in pregnant women: a systematic review

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