Modern Metabolic Health with Dr. Lindsay Ogle, MD

Breastfeeding And GLP-1s

• Lindsay Ogle, MD • Episode 3

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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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Speaker:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. For women who are on a GLP1 medication for type 2 diabetes or the disease of obesity, the current recommendation is to stop the GLP 1 medication in preparation for a pregnancy if it's a planned pregnancy, or to stop the medication once you find out that you're pregnant, and then not to start until you are done breastfeeding. This recommendation is made out of an abundance of caution and because we lack quality studies and real-world long-term evidence of the safety of these remarkable medications. But for any woman who has been on a GLP1 medication and experienced the many benefits of this treatment, they are very anxious to restart their medication after pregnancy. The good news is that there has been a recent study that gave really great information specifically about semaglutide and whether or not that is expressed in the breast milk for women who are still breastfeeding. Today we're gonna talk about that study and what it means for women who are planning pregnancies and are on a GLP1 medication. As mentioned in the intro, I am a physician and I'm sharing general medical knowledge. This is not direct medical advice, and this is something that you should take back to your doctor to have the individualized advice that is best for you. This is not medical advice, just general medical knowledge. So the study that we're talking about today will be linked below, and it is free to access so you can read it all on your own. We're gonna go over the big takeaways together. So this study looked at eight individual women who were on a GLP 1 medication. They had a baby recently and were breastfeeding, and they restarted their GLP1 medication. All of them were at least six months postpartum, and they took it for at least three weeks to get the medication back into their system. So then the researchers took their breast milk at the same time they did their GLP1, their semaglutide injection. They also took a sample 12 hours later, and then again 24 hours later to test for the presence of semaglutide. And just a reminder: the brand names of semaglutide are Ozempic and Wigovi. So this study was specific to those medications. They did not test for trazepitide brand names Zeppound and Monjaro. And very perhaps surprisingly, they did not find any detectable levels of semaglutide in the breast milk of these women. Now, this is really exciting news because it opens the door for further studies. Again, this was only eight women, so it doesn't represent the entire population, but it's very, very promising that GLP1 medications, specifically semaglutide, are likely safe during breastfeeding. Specifically, that they are not transferred from the woman's body to baby because there are undetectable levels in breast milk. What was really great that these researchers did was they utilized an equation which was fairly complicated, but it was able to even estimate like a worst-case scenario possibility if some of that medication did get into the breast milk. And it was a very, very low quantity. Again, worst-case scenario that would be transferred into the breast milk that was well below the predefined cutoff for safety in breast milk. So that estimate is called relative infant dose or RID. And for this study, that was found to be 1.26%. And the safety threshold cutoff is 10%. It's also important to note that this study looked at a few different doses that they looked at the starting dose is 0.25, the next dose 0.5, and then 1 milligram of semaglutide. They did not have any testing for higher doses, but that estimate did take that into account. And so they would estimate that if they did find any of semaglutide in the breast milk for women who are on semaglutide, Wegovy or Ozempic, it would be a very low amount, but that was not directly tested in this study. And why further studies are required before major societies like the Endocrine Society is going to recommend restarting GLP1 medications during breastfeeding. Right now, this study is not enough to recommend that it is safe to restart GLP1 medications during breastfeeding, especially when looking at a broad population. But it does open the door for a conversation with your medical provider. With anything in medicine, when we are determining a treatment, we are weighing the risks and the benefits of that treatment. And specifically for breastfeeding and for treating metabolic conditions like type 2 diabetes and obesity, we need to take both things into account. I say this because we often overestimate the risk of a woman taking a medication while breastfeeding and underestimate the risk of not treating that condition. So this is a great way to start that conversation. And what is your individual risk? Because that does vary from person to person. So a few things to think about. One is that this did not look at long-term results. And so that is something that further studies will show. It also did not look at trusepatide, so we cannot extrapolate this information to reflect what would happen for women who are taking Zepbound or Mounjaro. And then another really important thing is that it did not have the opportunity to look at maternal nutrition and what potentially limiting maternal nutrition via a GLP1 medication will do for baby's overall health and growth trajectory. This is extremely important to consider because women who are breastfeeding are going to need extra nutrients to have the stores and the energy to pass that on to baby. So if you are taking a medication that is suppressing your appetite to the point where you're not able to get that adequate nutrition, then not only is that going to be detrimental to your own health and increase risks like nutritional deficiencies, hair loss, muscle wasting, it also will impact baby's nutrition, may slow baby's growth, may um affect brain development. It can have a really negative impact on baby that we may not see immediately. So again, just because we're not seeing semaglutide transferred from mom to baby via breast milk, that does not mean that taking semaglutide while breastfeeding is the best option for you and baby, because we need to make sure you are still optimizing your nutrition. And this is where utilizing a dietitian and working with a board-certified obesity medicine physician is crucial. I do think there is space for uh GLP1 medication, as of right now, semaglutide during breastfeeding, probably at a lower dose than what you were on before, 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 nutrition that you and baby need for long-term health. This study, in my opinion, was extremely important. It was the start of studying the use of GLP1 medications during breastfeeding. What we learned is that semaglutide is not detected in breast milk, at least for these eight women, we need larger studies to confirm that. We also need to study what is the implication of GLP1 medications during breastfeeding. How is that impacting mom and baby's nutrition? And how does that impact their health long term? We do know that breastfeeding is one of the best things that you can do for your newborn. So we want to do as much as we can to encourage that for at least six to 12 months to optimize baby's health. We also know that we need to treat mom's metabolic condition. So again, we're going back to weighing those risks and benefits in this situation. Talk to your doctor, find out what is best for you, and subscribe to this channel so that you will get ongoing updates as more research is done in this area because I anticipate there's going to be a lot more research in this area to better optimize maternal and fetal health. I hope this was helpful and I hope you take this information and share it with somebody who would benefit a woman who is on a GLP 1, or maybe a close friend or family member who is on a GLP 1 and is maybe planning a pregnancy in the future. I'm sure this would be really great information for her to have.