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.

"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 safety data are still thin. The most reassuring current evidence is also the most preliminary: a large registry analysis found no clear increase in major congenital malformations among pregnancies exposed to GLP-1 receptor agonists early on¹, and a multicentre prospective cohort likewise did not detect a strong reproductive-safety signal². That is genuinely encouraging — but "no strong signal in early data" is not the same as "proven safe," and every author of that work says so. The practical takeaway for your OB conversation is simple: these drugs are stopped before a planned pregnancy, and because some have a long half-life, that means planning a washout window with your clinician rather than stopping the week you decide to try.

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

This is the question most women do not know to ask. GLP-1 medications slow gastric emptying, and that can affect how an oral medication — including an oral contraceptive — is absorbed, particularly in the weeks after you start or increase the dose. The FDA's own consumer guidance on these medicines underscores how much is still being sorted out about their real-world use³. The concrete move is to ask your OB whether you should add a backup barrier method for the first month and after any dose increase, or switch to a contraceptive route that does not depend on gut absorption. An unplanned pregnancy on a drug you are supposed to stop before conceiving is precisely the scenario this conversation exists to prevent.

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

Bring your OB into the loop on 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. If you are choosing a provider, this is exactly the kind of clinical oversight our editors weigh most heavily — you can see how we score it and which providers earned the top marks. A program that treats you as a whole person, not a prescription, is one your OB can safely coordinate with.

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. I want to talk about pregnancy timing, whether my birth control still works, and what we should monitor."* That single sentence turns a rushed refill into real care. This column is educational and is not medical advice; every decision here belongs to you and your clinician.