Sumathi Reddy's Your Health column on Wednesday opens with two rules that haven't changed. Quit a GLP-1 a month or two before you try for a baby. Stay off it while you're pregnant. Then comes the new part. The American College of Obstetricians and Gynecologists put out its first GLP-1 guidelines on Friday. On nursing, they soften. Wait until the baby is one month old. Then talk with your doctor about the pros and cons.
That's a real shift. The old advice from most doctors was blunt. No GLP-1 until the baby is weaned. Dr. Yvette LaCoursiere of UC San Diego helped write the guidelines. She told the Journal they aren't an endorsement. They support a conversation that weighs the mother and the baby. GLP-1s change how the body absorbs calories and nutrients. Nobody yet knows what that does to breast milk.
The early data are mildly reassuring. A small study found no semaglutide, the drug in Ozempic and Wegovy, in breast milk at 0, 12 or 24 hours after an injection. That was for the injected drugs. ACOG still advises against the pill forms while nursing. It also says to watch the baby's weight closely and to skip the drugs with a preterm infant. There are no human milk studies yet on milk volume, what's in it, or how babies grow.
Mothers got there first
Many mothers didn't wait for a guideline. A Facebook group called “Breastfeeding & Pumping Moms on GLP-1” started about a year ago. It has more than 10,000 members. One moderator, a 37-year-old New Jersey mother, estimates about half started without telling their doctor. She began Mounjaro about nine months ago while still nursing and says her milk supply has dipped. The numbers back her up. Postpartum GLP-1 starts rose 24-fold between 2018 and 2025, from 0.08% to 1.9% of women within six months of delivery, per a JAMA research letter. One obesity doctor told the Journal a body can take one to two years to settle after a birth. Starting a long-term drug at three months may be too soon, she said.
Our read
This is Health Costs, and for a lot of our readers it's a grandparent's story too. The planning point is plain. GLP-1s have become a household budget line, and the window for them now includes the months after a birth. They aren't cheap, and coverage varies by plan and by reason. So before anyone in the family starts or restarts one, we'd take three steps. Talk with the doctor first. About half of that Facebook group skipped that step, by one moderator's estimate. Check what the plan covers for weight loss versus diabetes, and what the monthly cost is after the deductible. Then write that number into the budget for a year, since this is long-term medicine. The Journal's story names brands, not the companies behind them, so we'll leave the tickers out. Nothing changes in our books.
The one thing in your plan this touches is the health line in the family budget. If a daughter or daughter-in-law is weighing this, the cost lands somewhere, and sometimes on the grandparents. The check this week is a ten-minute look at the plan's drug list for these brands and what they cost per month. Put the real number in the budget before the first refill, and bring it to your next review. It's easier to find the umbrella before the sky turns.