Rybelsus (semaglutide) is not recommended for use during pregnancy. This oral GLP-1 receptor agonist, licensed in the UK for type 2 diabetes management in adults, should be discontinued at least 2 months before a planned pregnancy. Animal studies have shown adverse developmental outcomes, and there is insufficient human safety data to assess risks to the developing foetus. Women of childbearing potential taking Rybelsus must use effective contraception. If pregnancy occurs whilst taking this medication, stop immediately and contact your GP or diabetes specialist the same day. Insulin therapy remains the gold standard for managing diabetes safely during pregnancy, with well-established safety data and proven effectiveness for both maternal and foetal health.

Can You Take Rybelsus While Pregnant?

Rybelsus (semaglutide) is not recommended for use during pregnancy. This oral medication, which belongs to a class of drugs called GLP-1 receptor agonists, is licensed in the UK for the treatment of type 2 diabetes in adults. However, the Medicines and Healthcare products Regulatory Agency (MHRA) and the manufacturer advise against its use in pregnant women due to insufficient safety data and potential risks to the developing foetus.

The primary concern stems from animal studies that have shown adverse developmental outcomes when semaglutide was administered during pregnancy. Whilst these findings in animals do not always translate directly to humans, they raise significant safety concerns that warrant a precautionary approach. Women of childbearing potential taking Rybelsus should use effective contraception, and the medication should be discontinued at least 2 months before a planned pregnancy.

Currently, there is limited human data on the effects of Rybelsus during pregnancy, making it impossible to fully assess the risks to both mother and baby. The potential for harm, combined with the availability of safer, well-established alternatives for managing diabetes in pregnancy, means that healthcare professionals will typically recommend switching to a different treatment regimen before conception or as soon as pregnancy is detected.

If you are taking Rybelsus and discover you are pregnant, you should stop the medication immediately and contact your GP or diabetes specialist on the same day. Uncontrolled blood glucose levels can pose serious risks during pregnancy, so your healthcare team will work with you to establish a safe and effective alternative treatment plan that protects both your health and your baby's development.

Why Rybelsus Is Not Recommended During Pregnancy

The recommendation against using Rybelsus during pregnancy is based on several important factors relating to drug safety and foetal development. Animal reproduction studies have demonstrated adverse effects on the developing foetus when pregnant animals were exposed to semaglutide. According to the European Medicines Agency's assessment report, these included skeletal abnormalities and reduced foetal growth, although these occurred at doses higher than typical human doses and in the context of maternal weight loss. These findings are sufficient to raise concerns about potential developmental effects.

Semaglutide works by mimicking the action of glucagon-like peptide-1 (GLP-1), a naturally occurring hormone that stimulates insulin secretion, suppresses glucagon release, and slows gastric emptying. This mechanism of action helps to lower blood glucose levels in people with type 2 diabetes. However, as stated in the product information, there is insufficient human data on the use of semaglutide in pregnant women to determine the risks. Given that glucose regulation is critical for normal foetal growth and organ development, any medication that significantly alters maternal glucose dynamics requires careful evaluation during pregnancy.

Additionally, Rybelsus can cause gastrointestinal side effects such as nausea, vomiting, and reduced appetite, which may lead to inadequate nutritional intake—a particular concern during pregnancy when nutritional demands are increased. Weight loss, which can occur with semaglutide treatment, is generally not desirable during pregnancy and could potentially compromise foetal growth.

The Summary of Product Characteristics (SmPC) for Rybelsus clearly states that it should not be used during pregnancy and should be discontinued at least 2 months before a planned pregnancy. This precautionary stance reflects the principle that medications should only be used in pregnancy when the benefits clearly outweigh the risks, and in this case, safer alternatives are readily available for managing diabetes during pregnancy.

Managing Type 2 Diabetes Safely During Pregnancy

Effective diabetes management during pregnancy is crucial for both maternal and foetal health. Poorly controlled blood glucose levels increase the risk of complications including miscarriage, pre-eclampsia, premature birth, macrosomia (excessive foetal growth), and congenital abnormalities. Conversely, well-managed diabetes significantly reduces these risks and improves outcomes for both mother and baby.

Insulin therapy is the gold standard treatment for diabetes during pregnancy. Unlike oral medications, insulin does not cross the placenta and has decades of safety data supporting its use in pregnant women. NICE guidelines (NG3) recommend that women with pre-existing type 2 diabetes who become pregnant should be offered intensive insulin therapy, typically involving multiple daily injections (MDI). Continuous subcutaneous insulin infusion (insulin pump therapy) may be considered in specific circumstances, primarily for women with type 1 diabetes or selected cases of type 2 diabetes under specialist care. Your diabetes team will work closely with you to adjust insulin doses throughout pregnancy, as insulin requirements typically increase, particularly in the second and third trimesters.

Blood glucose monitoring becomes more intensive during pregnancy, with target levels that are tighter than for non-pregnant individuals. NICE recommends fasting plasma glucose levels of 5.3 mmol/L or below, and one-hour postprandial levels of 7.8 mmol/L or below (or two-hour postprandial levels of 6.4 mmol/L or below). Many women will be advised to check their blood glucose levels before meals, one to two hours after meals, and before bed. Continuous glucose monitoring may be offered to women with type 1 diabetes and considered for those with type 2 diabetes on insulin therapy where clinically indicated.

Dietary management and physical activity remain important cornerstones of diabetes care during pregnancy. You should receive individualised advice from a specialist dietitian regarding carbohydrate intake, meal timing, and nutritional requirements. Regular, moderate physical activity—unless contraindicated—can help improve glucose control and overall wellbeing. Your care will involve a multidisciplinary team including obstetricians, diabetes specialists, midwives, and dietitians, with more frequent antenatal appointments than in uncomplicated pregnancies.

Women with diabetes are at higher risk of pre-eclampsia, and NICE guidance (NG133) recommends low-dose aspirin (75-150mg daily) from 12 weeks of pregnancy to reduce this risk. Additionally, an HbA1c target of 48 mmol/mol (6.5%) or lower is recommended during pregnancy if achievable without problematic hypoglycaemia.

What to Do If You Become Pregnant While Taking Rybelsus

If you discover you are pregnant whilst taking Rybelsus, stop the medication immediately and contact your GP or diabetes specialist on the same day. This is not a cause for panic, but prompt action is necessary to ensure your diabetes remains well controlled whilst transitioning to a pregnancy-safe treatment regimen. The Summary of Product Characteristics (SmPC) for Rybelsus clearly states that the medication should be discontinued as soon as pregnancy is recognised.

Your healthcare team will arrange an urgent review to assess your current diabetes control and initiate an alternative treatment plan, typically involving insulin therapy. The transition from Rybelsus to insulin requires careful planning and education. You will receive training on insulin injection technique, dose adjustment, recognition and treatment of hypoglycaemia, and intensified blood glucose monitoring. This transition period may feel overwhelming, but your diabetes team will provide comprehensive support throughout.

It is important to inform your healthcare provider about the timing and duration of Rybelsus exposure during early pregnancy. Whilst the risk of harm is uncertain, this information will help your obstetric team plan appropriate foetal monitoring and screening. You may wish to discuss any concerns about medication exposure with the UK Teratology Information Service (UKTIS) through your healthcare provider, or access patient information via the BUMPS (Best Use of Medicines in Pregnancy) website. You will likely be referred to a specialist antenatal clinic for high-risk pregnancies, where you will receive enhanced surveillance including detailed ultrasound scans to assess foetal growth and development.

Additionally, you should commence folic acid supplementation at a higher dose (5mg daily) if you have not already done so, as recommended for all women with pre-existing diabetes. This helps reduce the risk of neural tube defects. Your healthcare team will also review any other medications you are taking to ensure they are safe during pregnancy, and will discuss the importance of achieving optimal glucose control throughout your pregnancy to minimise complications. Remember that with appropriate management and support, women with type 2 diabetes can have healthy pregnancies and babies.

Alternative Diabetes Treatments for Pregnant Women

Insulin remains the primary and safest pharmacological treatment for managing both type 1 and type 2 diabetes during pregnancy. Multiple types of insulin are available and considered safe for use in pregnancy, including rapid-acting analogues (such as insulin aspart and insulin lispro), short-acting human insulin, intermediate-acting insulin (NPH), and long-acting analogues. Your diabetes team will design an individualised insulin regimen based on your glucose patterns, lifestyle, and preferences. Most women with type 2 diabetes will require a basal-bolus regimen, which involves a long-acting background insulin combined with rapid-acting insulin administered before meals.

Metformin is the only oral diabetes medication that may be considered during pregnancy in certain circumstances. Whilst metformin does cross the placenta, extensive safety data—including long-term follow-up studies of children exposed in utero—have not identified significant adverse effects. NICE guidelines (NG3) state that metformin may be used in pregnancy for women with type 2 diabetes, either alone or in combination with insulin, particularly when insulin alone does not achieve adequate glucose control or when women decline insulin therapy. However, metformin is not licensed for use in pregnancy in the UK, so its use represents off-label prescribing that requires informed discussion and consent.

Glibenclamide (glyburide), a sulphonylurea, has limited use in UK practice, primarily for gestational diabetes when metformin is unsuitable and insulin is declined, rather than for pre-existing type 2 diabetes. Most other oral diabetes medications, including other sulphonylureas, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists like Rybelsus, should be discontinued before conception or as soon as pregnancy is confirmed.

Non-pharmacological interventions remain fundamental to diabetes management during pregnancy. These include medical nutrition therapy tailored to pregnancy requirements, regular physical activity (as appropriate), and structured education about diabetes self-management. Blood glucose monitoring—whether through traditional finger-prick testing or continuous glucose monitoring systems—provides essential information for treatment adjustment. Your multidisciplinary team will support you in achieving optimal glucose control whilst minimising the risk of hypoglycaemia, ensuring the best possible outcomes for you and your baby.

After delivery, insulin and metformin are both compatible with breastfeeding. GLP-1 receptor agonists like Rybelsus are not recommended during breastfeeding due to insufficient safety data. If you experience any suspected side effects from diabetes medications during pregnancy or breastfeeding, report them through the MHRA Yellow Card Scheme.

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