Ozempic Pregnancies, Meet Abortion Bans

Here’s a gigantic head’s up, especially to people living in states with abortion bans: Women taking drugs like Ozempic and Mounjaro to treat diabetes or to lose weight are reporting surprise pregnancies—even if they’ve had fertility problems in the past, or were taking birth control pills. This could be a blessing to some folks and a nightmare to others, but the stakes of an unintended pregnancy are ratcheted up thanks to the Supreme Court’s 2022 Dobbs decision.

Jezebel reviewed prescribing information for multiple drugs and contacted popular telemedicine services about how they advise clients prescribed medications like Ozempic—known as glucagon-like peptide 1 agonists, or GLP-1s. The warnings about interactions with other oral medications are there, but they’re not as obvious as they should be considering that some of the states with the highest rate of GLP-1 prescriptions are also states with abortion bans.

Experts say it’s possible that people are getting pregnant on these drugs because weight loss can help treat insulin resistance, which can lead to more regulated ovulation and menstrual cycles. (Conceiving requires timing around when the ovaries release an egg.) But the medications work by slowing stomach emptying, and that can affect the absorption of oral medications when they’re taken at the same time. The drugs can also cause vomiting and diarrhea, which could mean people aren’t absorbing enough of their birth control pill to prevent pregnancy.

Prescription data shows the drugs are taking off in the South, most notably in states that have both high obesity rates and abortion bans. According to one analysis published in Axios, the 10 states with the highest rate of GLP-1 prescriptions relative to population in 2023 were: Kentucky, West Virginia, Alaska, Mississippi, Louisiana, Tennessee, Alabama, Arkansas, Idaho, and North Dakota. Nine out of those 10 states ban abortion—only Alaska does not.

Animal studies suggest GLP-1s can cause birth defects and miscarriage, which is why the majority of the manufacturers say to stop using the drugs during pregnancy, and at least two months before a planned pregnancy. (It can take a lot of people more than two months to get pregnant so that advice isn’t very helpful.)

So to recap, people are getting unexpectedly pregnant on these drugs, which can cause birth defects and miscarriages, at the same time that 20 states ban abortion at 15 weeks of pregnancy or earlier. Abortion bans also affect people’s ability to get timely care for pregnancy loss and fetal anomalies, as Jezebel has reported in excruciating detail.

Manijeh Kamyar, a maternal-fetal medicine specialist and OB/GYN in Nevada, told Today that many of her patients say no one has discussed the risks of Ozempic during pregnancy with them. “I think that that’s a huge gap in the use of this medication, especially when something like this ramps up so quickly,” she said. “If you accidentally get pregnant while on this, I don’t know what that’s going to mean for your pregnancy…I cannot guarantee the safety of this medication in pregnancy.”

Jezebel reviewed the prescribing information for seven brands of GLP-1s, and while all of them noted potential impacts on oral medications, only Mounjaro and Zepbound (brand names for tirzepatide) tell doctors to advise patients about effects on oral contraception when they start the medication or increase their dose. The manufacturer writes that doctors should tell patients to switch to non-oral methods or add a barrier method like condoms or diaphragms. The rest of the pamphlets merely say that the drugs could affect the absorption of other prescriptions and that patients should tell their doctor about all other medications they take.

You can read the prescribing information for common GLP-1s yourself: Mounjaro, Ozempic, Rybelsus, Saxenda, Trulicity, Wegovy, and Zepbound. The manufacturers did test tube or petri dish studies on birth control pills (containing ethinylestradiol and either norgestimate or levonorgestrel) to see if the GLP-1 affected contraception. Buried in Trulicity’s prescribing information is the fact that researchers didn’t study its effects on the pill, but instead the patch (norelgestromin and ethinyl estradiol). That’s not very useful when the theoretical cause for concern is the drugs’ impact on birth control taken by mouth.

It’s also possible that GLP-1s could affect morning-after pills like Plan B.

Probably the same for emergency contraception I imagine!

— Asha (@ReproResearcher) March 25, 2024

It’s impossible to know how all providers are counseling patients on potential interactions between GLP-1s and birth control pills, but it has become clear that doctors who don’t practice endocrinology or bariatric medicine are offering the drugs, and advertising them. Jezebel contacted telehealth GLP-1s prescribers for comment including Ro, WeightWatchers Clinic, and Noom Med. 

WeightWatchers medical director Spencer Nadolsky, an obesity and lipid specialist, told Jezebel that all patients taking GLP-1s are informed about interactions with birth control. (WeightWatchers offers Saxenda, Wegovy, and Zepbound.) “Members receive automated messages about the risks of birth control while using GLP-1s, one of which is a risk of decreased oral contraceptive birth control effectiveness,” he said. “This goes for when starting GLP-1 medications and when ramping up the GLP-1 dosage each month. Our providers are trained to talk about the risks with patients during their initial visit and throughout their care plan.” He added that, “to mitigate risk, it is recommended to use a secondary method of contraception in addition to your oral contraceptives when you start the medicine and every time you go up in the dose, for four weeks at a time.”

Ro prescribes Ozempic, Saxenda, Wegovy, Zepbound, and compounded semaglutide. A spokesperson said only patients taking Zepbound are told about the risks with birth control. “All female-born patients are informed about and must attest to their understanding that Zepbound can interact with oral contraceptives (birth control pills) before being prescribed the medication,” the spokesperson said. They added that “when prescribing Zepbound, Ro-affiliated providers counsel patients about this interaction as well as give recommendations for those on birth control.” Ro patients taking other GLP-1 drugs receive a guide that mentions impacts on oral medications but doesn’t call out contraception. It reads: “One of the effects of GLP-1s is decreasing the speed of gastric emptying or the speed that material moves through your gastrointestinal tract. Due to this, it can change the absorption of medications taken by mouth. It’s important to tell your Ro-affiliated provider all of the medications you are currently taking.”

Noom Med—which prescribes Mounjaro, Ozempic, Rybelsus, Saxenda, Trulicity, Wegovy, and Zepbound—did not respond to a request for comment by publication time.

Still, the interaction between GLP-1s and birth control would be limited to pills, because they work in the GI tract. Other forms of contraception, like the patch, ring, shot, or IUD, work either in the bloodstream or the uterus and wouldn’t be affected by slowed emptying of the stomach.

So, just keep all of this in mind if you’re considering taking this class of drug, especially if you live in a state that bans abortion. It turns out GLP-1s are so new that there isn’t enough data, but more and more people are getting pregnant.