Ozempic and pregnancy: what the birth defect data actually shows

What did @realdrbae actually say?

The creator, a board-certified plastic surgeon, made a two-track argument: if you're diabetic and on semaglutide (Ozempic), you might be able to keep taking it during pregnancy, but if you're using Wegovy purely for weight loss, "stop that immediately once you find out you're pregnant." The reasoning? Animal studies showed birth defects, human studies so far haven't, and diabetics already carry elevated baseline birth defect risk regardless of medication. He also acknowledged, correctly, that no ethical trial will ever deliberately enroll pregnant women to test this.

That's actually a more nuanced take than most TikTok medical content. He didn't say Ozempic is safe in pregnancy. He drew a risk-benefit distinction between two patient populations, and he landed on a conservative recommendation. That matters.

Does the science back this up?

Mostly, yes, with some important caveats. The animal data showing fetal harm is real and well-documented. The human data is limited but not alarming, so far.

The study he appears to be referencing is likely Winther et al. (2024, JAMA Internal Medicine), which analyzed outcomes in women who became pregnant while on GLP-1 receptor agonists. It found no statistically significant increase in major birth defects compared to unexposed controls. A separate Danish registry study by Moller et al. (2024, Annals of Internal Medicine) also found no significant increase in congenital malformations in GLP-1 exposed pregnancies, though the sample sizes were relatively small and exposure timing varied.

His point about diabetics having a higher baseline risk of birth defects is well-established. Uncontrolled pregestational diabetes is associated with a two-to-five-fold increased risk of congenital malformations, according to data published by Balsells et al. (2016, BMJ). So his logic that "even on these medications, diabetics didn't show increased risk" has to be read against that baseline, not zero.

What did they get wrong (or right)?

He got the broad strokes right. The animal-study-versus-human-study distinction is accurate. The baseline diabetes risk point is accurate. The recommendation to stop for weight-loss use is consistent with current FDA labeling and guidance from ACOG.

Where it gets fuzzy: he implies that diabetic patients "may still be able to continue" Ozempic during pregnancy, framing it as a reasonable option. That's a stretch. Current FDA labeling for semaglutide says to discontinue at least two months before a planned pregnancy. ACOG and most maternal-fetal medicine specialists recommend stopping GLP-1 agonists once pregnancy is confirmed, regardless of the indication. The risk-benefit calculation for continuing in a diabetic patient is a conversation with a maternal-fetal medicine specialist, not a TikTok takeaway.

He also calls himself a "board-certified plastic surgeon" giving metabolic medication advice. That's worth noting. Plastic surgeons are physicians, but this is outside the typical scope of obstetric or endocrine expertise. The data he's citing is real, but the clinical nuance here warrants specialist input.

What should you actually know?

Here's the practical picture. Semaglutide is not approved for use during pregnancy. Animal studies in rats and rabbits showed dose-dependent fetal harm, including structural abnormalities and reduced fetal weight, at exposures relevant to human doses. Human observational data is accumulating but still limited in size and follow-up duration.

The two-month washout recommendation before planned pregnancy exists because semaglutide has a roughly one-week half-life, meaning it takes several weeks to fully clear. If you're on Wegovy or Ozempic and planning to conceive, this is a conversation to have with your prescriber now, not after a positive test.

For diabetic patients who become pregnant unexpectedly while on semaglutide, the standard of care shifts to insulin, which has decades of pregnancy safety data. There is no established clinical scenario where continuing semaglutide through pregnancy is the recommended first-line approach.

• Stop GLP-1 medications when pregnancy is confirmed, or ideally two months before planned conception.
• If you have diabetes and become pregnant, work with an OB or maternal-fetal medicine specialist to switch to an insulin regimen.
• Human data so far is reassuring but limited. "Reassuring so far" is not the same as "proven safe."
• The FDA pregnancy exposure registry for semaglutide is ongoing. If you were exposed, you can enroll at 1-800-727-6500.