Safety of Using Semaglutide During Lactation

CQ #309 – September 17, 2024
by Anne Eglash MD, IBCLC, FABM
#LACTFACT
Semaglutide appears to be safe during lactation due to minimal transmission into breastmilk.
Nutrients 2024, 16, 2886


Is semaglutide safe to take during lactation?

Semaglutide is a glucagon-like peptide 1 agonist (GLP-1) prescription medication that was originally indicated to treat type 2 diabetes and since then has been found to lower the risk of heart attack, stroke or death among people with type 2 diabetes. The Wegovy brand of semaglutide has US FDA approval for weight loss, and as of June 2024, 12% of US adults have used semaglutide or a related GLP-1 agonist medication.

Semaglutide is highly effective at reducing weight by increasing the sensation of abdominal fullness and reducing appetite, leading to a decrease in calorie intake.

Many lactation professionals have been asked if semaglutide can be resumed postpartum during lactation, as many individuals struggle with losing the weight gained during pregnancy.

The study for this week evaluated the transmission of semaglutide into breastmilk among 8 women by evaluating milk samples expressed at 0, 12, and 24 hours after a self-administered subcutaneous dose. The average weight among the 8 subjects was 93 kg, with a mean dose of 0.56mg of semaglutide subcutaneously each week.

How much semaglutide was found in breastmilk? See the question!

Please choose accurate statements regarding the use of semaglutide during lactation. Choose 1 or more:
  1. Semaglutide was not detected at the limit of quantification in any of the milk samples.
  2. Semaglutide was detected in milk samples, with a relative infant dose (RID) of 5%.
  3. The peak maternal plasma level of semaglutide was on day 5.
  4. GLP-1 is naturally found in breastmilk.

See the Answer


Correct Answers: A and D (not B or C)

Nutrients 2024, 16, 2886
Hanin Diab, Taylor Fuquay, Palika Datta, Ulrich Bickel, Jonathan Thompson, Kaytlin Krutsch

Abstract

Postpartum mothers and their healthcare providers often face the challenge of limited data regarding the safety of drug therapies during lactation. Pregnancy can lead to sustained weight gain, and obesity can negatively impact both physical and psychological well-being. The introduction of GLP-1 agonists to augment weight loss has become a topic of interest for many postpartum mothers. Our study aims to investigate the transmission of semaglutide into human milk in the first steps to ensure the safety and health of both lactating mothers and their breastfed infants. Semaglutide quantification was performed using high-resolution liquid chromatography-mass spectrometry. InfantRisk Center Human Milk biorepository released milk samples from eight women collected at 0, 12 and 24 h post-semaglutide administration. Semaglutide was extracted using protein precipitation in methanol, followed by chromatographic separation. Linear calibration curves for the method ranged between 2.5–30 ng/mL, with a limit of detection of 1.7 ng/mL and a limit of quantification of 5.7 ng/mL (LLOQ). Semaglutide was not detected in any of the collected human milk samples. A worst-case scenario of the relative infant dose (RID) was calculated using the LLOQ as the drug concentration in milk when considering semaglutide’s bioavailability and long-acting dose profile. The maximum RID projected was 1.26%, far below the standard 10% safety threshold. While questions about long-term infant outcomes, the safety of maternal nutrient intake, and the nutrient content of breast milk remain, our findings suggest that semaglutide concentrations in human milk are unlikely to pose clinical concerns for breastfed infants. These results support healthcare providers in making informed decisions regarding postpartum therapeutic interventions.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

The good news is that semaglutide is not transmitted into breastmilk, at least to the lower limit of detection. The peak maternal serum level for semaglutide is on day 2 after injection, although not much higher than on day 1. Interestingly, GLP-1 is made by mammary epithelium and is naturally present in breastmilk. It may act as a hormone of appetite regulation for the infant.

The authors warned that this study did not evaluate any possible changes to human milk composition from semaglutide.

It is important to consider that use of semaglutide among lactating individuals can increase the risk of excessive weight loss, resulting in insufficient nutrient intake and a drop in milk production from insufficient calories. People taking semaglutide should be advised to take multivitamins and need close follow up to monitor for excessive postpartum weight loss and milk production issues.

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