What to Tell Your OB Before You Start a GLP-1

The appointment most telehealth intakes skip

A good telehealth intake asks about your thyroid history and your medications. What it often does not do — not the way a person who knows you would — is sit with the questions that matter specifically for a woman who may still want to be pregnant, or is not certain she does not. Those questions belong to your OB-GYN, and they are worth a dedicated appointment before your first injection, not an afterthought once you have started. Here is what to put on the table, and where the two big drug families quietly part company.

An unplanned pregnancy on a drug you are supposed to stop months before conceiving is exactly the scenario this one appointment exists to prevent.

"I'm not planning a pregnancy — but if that changed"

GLP-1 medications are not to be used in pregnancy, and the honest reason is that the human safety data are still thin rather than alarming. Two studies are usually offered as reassurance, and both deserve to be read with their comparison group attached.

The larger is a population-based cohort drawn from four Nordic countries, a US claims database and an Israeli health service, restricted to pregnant women with type 2 diabetes. Among 938 infants exposed to a GLP-1 receptor agonist around conception, the standardized prevalence of major congenital malformations was 8.3%; compared with insulin as the active comparator, the adjusted relative risk was 0.95 (95% CI, 0.72–1.26)¹. That is genuinely reassuring — but note what it is not. The 8.3% sits against 5.3% among all infants of women with type 2 diabetes and 3.7% across all infants in the data. The study says GLP-1 exposure did not add risk on top of the diabetes; it does not say the pregnancies were as low-risk as anyone else's.

The second is a prospective cohort assembled from six teratology information services: 168 first-trimester GLP-1 exposures, with major birth defects in 2.6% versus 2.3% in a diabetes reference group (adjusted OR 0.98) and 3.9% in an overweight/obese reference group². Encouraging — and the confidence interval on that first comparison runs from 0.16 to 5.82, meaning a near six-fold increase in risk has not been ruled out. The authors say so themselves and call for larger studies. "No strong signal in a small sample" is a real finding, and it is not the same sentence as "proven safe."

The stop date is drug-specific, and the gap is about two months

This is the part where blurring the drugs together does actual damage, so take it molecule by molecule.

The Wegovy (semaglutide) label instructs clinicians to discontinue the drug at least 2 months before a planned pregnancy, explicitly "to account for the long half-life of semaglutide"³. The Zepbound (tirzepatide) label carries no pre-pregnancy washout instruction at all; its direction is to discontinue when pregnancy is recognized⁴. Those are different calendars, and the semaglutide one has to be planned two cycles ahead of the month you start trying.

If you have seen "about a week per dose" quoted as the washout, that number is describing the half-life, not the instruction — and it understates the label's semaglutide window by a wide margin. Ask your OB to write the actual stop date down. Whichever molecule you are on, the maternal-fetal medicine review of GLP-1 use in pregnancy ends on an unambiguous line: the authors recommend that all patients use contraception to prevent unintended pregnancy while taking these drugs⁵.

"Here's my contraception — does it still work the way I think?"

Most women do not know to ask this, and the answer depends entirely on which drug you are handed.

Tirzepatide (Zepbound, Mounjaro). The label is direct: it may reduce the efficacy of oral hormonal contraceptives because of delayed gastric emptying, a delay that is largest after the first dose and diminishes over time. The instruction is to switch to a non-oral contraceptive method, or add a barrier method, for 4 weeks after initiation and for 4 weeks after each dose escalation — and it adds that hormonal contraceptives not administered orally should not be affected⁴. So an IUD, implant, patch, ring or injection sidesteps the problem entirely.

Semaglutide (Wegovy, Ozempic). The word "contraceptive" does not appear anywhere in the Wegovy label³. There is no equivalent warning to follow, which is a real difference between the molecules and worth weighing if the pill is what you want to keep using. We go through the mechanism and the numbers in GLP-1s and birth control.

The question patients are already carrying, and rarely say out loud

Researchers at the University of Missouri surveyed and interviewed 31 adults weighing whether to start a GLP-1 for weight loss. One participant, asked what would stop her, named contraception without being prompted: "I'll be honest, I'm on birth control and if there was a negative reaction to that, I would say my current medications are more important than weight loss."⁶

She was doing the exact risk calculation this article is about — and the study's broader finding is why it belongs in an OB's office rather than a chat window. Participants reported uncertainty about eligibility, long-term safety and what to expect, and the authors describe clear communication gaps: few participants initiated the discussion themselves, and outreach from clinicians was rare⁶. The conversation is not happening by default. Somebody has to start it, and if nobody else does, it has to be you.

"What should we watch, and who's actually monitoring me?"

Bring your OB into the practical medicine too: baseline labs, how nausea and reduced intake might interact with any prenatal vitamins or supplements you take, and whether your telehealth prescriber and your OB will actually talk to each other. Ask specifically whether the prescribing service will send notes anywhere. A program that treats you as a whole person, not a prescription, is one your OB can safely coordinate with; one that cannot name who is monitoring you is answering the question by not answering it.

It is worth knowing that a handful of programs already have this conversation before you do, and that the tell is whether they get the labeling right rather than whether they mention pregnancy at all. Allara Health asks about pregnancy and about trying to conceive in its public intake, and its published drug information carries both the two-month stop and the distinction between the semaglutide tablet, where breastfeeding is not recommended, and the injectables, where the instruction is to tell your provider — a difference a great many health pages flatten. That is not a reason to choose one brand over another. It is a useful way to judge whether the service you are about to hand your history to has read the same label your OB has.

The "who's monitoring me" question also has a structural answer, separate from labeling: does the program build lab review into an actual visit, or leave it to an intake form? Form Health puts a registered dietitian and a board-certified physician on every case with monthly video visits; Calibrate builds lab review directly into its scheduled 20-minute clinician video call. Neither replaces telling your OB yourself, but a program built around a recurring, named clinician is easier for an OB to actually coordinate with than a one-time async questionnaire.

Two more worth naming for the same reason: Neo Soma Healthcare publishes a named, licensed physician (Dr. Steven Bunker) and a real clinic address, and Mevo Health lists four named physicians on staff — both a more concrete answer to "who's monitoring me" than an anonymous intake form, even though neither publishes the pregnancy-specific intake language Allara Health does. Mixx Health & Wellness names its founding physician directly, and OnlyRx names four prescribers — again, neither publishes pregnancy-specific intake language the way Allara Health does, so raise it with your OB regardless of who's named on the site. Heros Health is worth naming for a different reason: dose adjustments and clinician messaging are built into its flat program price rather than billed as extras, and it backs a mismatch with a 100%-refund-if-not-medically-approved policy plus a separate 90-day money-back guarantee — real protection if your OB flags something a first intake missed. The Virtual NP names its own founder, Sandra Jordan, MSN, APRN, FNP-C, directly on its homepage — a named nurse practitioner is a more concrete answer than an anonymous intake form here too.

The one-line version to walk in with

If you remember nothing else, walk into the appointment and say: "I'm starting a GLP-1. Which molecule is it, how far ahead of a pregnancy do I have to stop it, does my birth control still work, and what are we monitoring?" That single sentence turns a rushed refill into real care.