Glucagon-Like Peptide-1 Receptor Agonists and Reproductive Health: A Narrative Review for Obstetrician-Gynecologists

The expanding use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs for obesity and type 2 diabetes has important implications for reproductive-aged patients. As these medications are increasingly prescribed before conception and after delivery, obstetrician-gynecologists need practical guidance on contraception, pregnancy planning, inadvertent pregnancy exposure, medication discontinuation, gestational weight trajectory, postpartum use, and lactation. This narrative review synthesizes current evidence on GLP-1 RA and dual GIP/GLP-1 RA use across the reproductive spectrum, including mechanisms relevant to ovulation and polycystic ovary syndrome (PCOS), pharmacokinetic interactions with oral hormonal contraceptives, animal and human pregnancy safety data, preconception washout recommendations, management after inadvertent early-pregnancy exposure, postpartum prescribing, breastfeeding considerations, and unresolved research gaps. Available evidence suggests potential reproductive benefits in some patients with metabolic dysfunction or PCOS, but current pregnancy and lactation data remain limited. Until stronger prospective safety data are available, counseling should be individualized, agent-specific, and centered on pregnancy intention, contraceptive reliability, metabolic risk, and shared decision-making.