Trulicity (dulaglutide) is not recommended during pregnancy and should be avoided if you are planning to conceive or discover you are pregnant. This GLP-1 receptor agonist, used to manage type 2 diabetes, lacks adequate safety data for use in pregnancy, and animal studies have shown adverse effects on foetal development. Insulin remains the gold standard treatment for diabetes during pregnancy, with decades of established safety data. If you are taking Trulicity and become pregnant, contact your GP or diabetes specialist immediately to discuss transitioning to pregnancy-safe alternatives that ensure optimal glucose control whilst protecting both maternal and foetal health.

Can You Take Trulicity When Pregnant?

Trulicity (dulaglutide) is not recommended during pregnancy and should generally be avoided if you are planning to conceive or discover you are pregnant. The UK Summary of Product Characteristics (SmPC) states that 'as a precautionary measure, it is preferable to avoid the use of dulaglutide during pregnancy'.

Dulaglutide belongs to a class of medications called GLP-1 receptor agonists, which are used to manage type 2 diabetes. Whilst these medicines are effective for blood glucose control outside of pregnancy, the safety profile during pregnancy has not been adequately established. Animal reproduction studies have shown adverse effects on fetal development, including skeletal abnormalities and reduced fetal growth, though it remains uncertain whether these findings translate directly to human pregnancy.

Pregnancy requires careful diabetes management to protect both maternal and fetal health, but this must be achieved using medications with proven safety records. Insulin remains the gold standard treatment for diabetes during pregnancy, as it does not cross the placenta and has decades of established safety data. For women with type 2 diabetes, metformin may also be continued or initiated during pregnancy according to NICE guidance.

If you are currently taking Trulicity and are pregnant, planning pregnancy, or suspect you might be pregnant, it is essential to contact your GP or diabetes specialist immediately to discuss alternative treatment options.

The decision to discontinue Trulicity and transition to pregnancy-safe alternatives should always be made under medical supervision, as uncontrolled diabetes during pregnancy carries significant risks including pre-eclampsia, macrosomia (large baby), and congenital abnormalities. Your healthcare team will work with you to ensure optimal glucose control throughout your pregnancy using appropriate medications.

How Trulicity Works and Its Use in Diabetes

Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist used to improve blood glucose control in adults with type 2 diabetes mellitus. It is administered as a once-weekly subcutaneous injection and works through several complementary mechanisms to lower blood sugar levels.

The primary mechanism of action involves mimicking the natural hormone GLP-1, which is released by the intestine in response to food intake. Dulaglutide stimulates insulin secretion from pancreatic beta cells in a glucose-dependent manner—meaning it promotes insulin release only when blood glucose levels are elevated. This reduces the risk of hypoglycaemia (dangerously low blood sugar) compared to some other diabetes medications, though this risk increases when combined with insulin or sulfonylureas. Additionally, Trulicity suppresses the release of glucagon, a hormone that raises blood glucose, further contributing to improved glycaemic control.

Beyond glucose regulation, dulaglutide slows gastric emptying, which helps reduce post-meal blood sugar spikes and promotes satiety. Many patients experience weight loss whilst taking Trulicity, which can be beneficial for managing type 2 diabetes, as excess weight often contributes to insulin resistance.

NICE guidelines recommend GLP-1 receptor agonists like Trulicity as a treatment option for adults with type 2 diabetes in specific circumstances, such as triple therapy (alongside two other diabetes medications) when certain BMI thresholds are met, or when insulin would have significant occupational implications. The medication is typically prescribed alongside lifestyle modifications including dietary changes and increased physical activity. Common adverse effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and abdominal discomfort, which usually diminish over time. However, these well-established benefits and uses in the general population do not extend to pregnancy, where safety considerations differ substantially.

Risks of Trulicity During Pregnancy

The primary concern regarding Trulicity use during pregnancy stems from limited human safety data and adverse findings in animal reproduction studies. The UK SmPC for dulaglutide states that 'as a precautionary measure, it is preferable to avoid the use of dulaglutide during pregnancy'.

Animal studies conducted during drug development revealed potential teratogenic effects (birth defects) when pregnant animals were exposed to dulaglutide. These studies showed skeletal abnormalities, reduced fetal weight, and developmental delays in offspring. Whilst animal studies do not always predict human outcomes, they raise sufficient concern to warrant caution.

There is insufficient data from human pregnancies to definitively characterise the risk profile. If you are planning a pregnancy, dulaglutide should be discontinued before conception—discuss the timing of stopping treatment and transitioning to pregnancy-appropriate alternatives with your diabetes team.

Beyond direct fetal effects, there are practical concerns about using Trulicity during pregnancy. The medication's gastrointestinal side effects—particularly nausea and vomiting—could exacerbate pregnancy-related morning sickness, potentially leading to dehydration and inadequate nutrition. Additionally, the appetite-suppressing effects and associated weight loss are generally undesirable during pregnancy, when appropriate weight gain is important for fetal development.

Uncontrolled diabetes itself poses substantial risks during pregnancy, including increased rates of miscarriage, pre-eclampsia, preterm birth, and congenital malformations. Therefore, whilst Trulicity should be avoided, it is equally crucial that diabetes management is not neglected. The focus must shift to pregnancy-safe alternatives that effectively control blood glucose without the uncertainties associated with GLP-1 receptor agonists.

According to UK Teratology Information Service (UKTIS) guidance, inadvertent exposure to dulaglutide during early pregnancy is not usually considered grounds for termination, but should prompt specialist review and appropriate fetal monitoring.

Safe Diabetes Management Options in Pregnancy

Insulin therapy remains the cornerstone of diabetes management during pregnancy and is recommended by NICE as the first-line pharmacological treatment for both pre-existing diabetes and gestational diabetes when lifestyle measures prove insufficient. Insulin has an extensive safety record spanning decades, does not cross the placenta, and can be precisely titrated to achieve optimal glucose control throughout pregnancy.

Several insulin regimens may be appropriate depending on individual circumstances. Basal-bolus regimens, combining long-acting background insulin with rapid-acting insulin at mealtimes, offer flexible and physiological glucose control. Alternatively, pre-mixed insulin formulations may be suitable for some women. Your diabetes specialist team will determine the most appropriate regimen and provide comprehensive education on insulin administration, dose adjustment, and hypoglycaemia management.

Metformin is increasingly used during pregnancy, particularly for gestational diabetes and pre-existing type 2 diabetes. Whilst metformin does cross the placenta, substantial evidence now supports its safety and efficacy during pregnancy. NICE guidelines acknowledge metformin as an option for gestational diabetes management, either alone or in combination with insulin. However, some women may prefer to avoid metformin due to gastrointestinal side effects or personal preference, in which case insulin remains the alternative.

Lifestyle modifications form the foundation of diabetes management during pregnancy. This includes:

• Dietary adjustments: Working with a dietitian to develop a balanced meal plan that controls carbohydrate intake whilst ensuring adequate nutrition for fetal development

• Regular physical activity: Moderate exercise as approved by your healthcare team, which improves insulin sensitivity

• Frequent blood glucose monitoring: Self-monitoring multiple times daily to track patterns and guide treatment adjustments

• Weight management: Achieving appropriate gestational weight gain based on pre-pregnancy BMI

Multidisciplinary care is essential. Your care team should include obstetricians, diabetes specialists, specialist midwives, dietitians, and potentially other professionals. Regular antenatal appointments with increased monitoring ensure both maternal and fetal wellbeing. NICE recommends specific glucose targets during pregnancy: fasting glucose below 5.3 mmol/L and one-hour post-meal glucose below 7.8 mmol/L, though individualised targets may be appropriate in certain circumstances.

What to Do If You're Taking Trulicity and Become Pregnant

If you discover you are pregnant whilst taking Trulicity, stop the medication immediately and seek same-day advice from your GP or diabetes specialist. Stopping dulaglutide is important to avoid continued fetal exposure, but you will need urgent specialist support to establish alternative diabetes management.

Your healthcare team will arrange an urgent review to transition your diabetes management. This typically involves commencing insulin therapy, with initial doses calculated based on your current glucose control, weight, and gestational age. For women with type 2 diabetes, metformin may be continued or initiated alongside insulin according to NICE guidance. You will receive education on insulin administration technique, blood glucose monitoring, and recognising hypoglycaemia symptoms. Many diabetes centres offer dedicated pre-pregnancy and pregnancy diabetes clinics with specialist midwives who can provide intensive support during this transition.

Increased monitoring will be implemented to ensure glucose control is optimised quickly. This may include more frequent blood glucose checks (typically before meals and one hour after meals), continuous glucose monitoring systems, and regular HbA1c measurements. Your healthcare team will also arrange additional antenatal surveillance, including early ultrasound scans to confirm dates and assess fetal development, and potentially more frequent growth scans later in pregnancy.

If you are planning pregnancy and currently taking Trulicity, ideally discuss this with your diabetes team before conceiving. Dulaglutide should be discontinued before attempting conception, with your diabetes team advising on the appropriate timing and transition to pregnancy-safe medications. Pre-conception counselling should also address:

• Folic acid supplementation: 5mg daily from at least 3 months before conception until 12 weeks' gestation to reduce neural tube defect risk

• Optimising glucose control: Aiming for HbA1c below 48 mmol/mol (6.5%) before conception if safely achievable

• Medication review: Ensuring all medications are pregnancy-safe, including blood pressure and cholesterol medications

• Retinal screening: As pregnancy can accelerate diabetic retinopathy

Do not delay seeking advice. Early intervention and appropriate diabetes management significantly improve outcomes for both mother and baby. Your healthcare team understands the complexities of managing diabetes during pregnancy and will provide comprehensive support throughout your journey.

If you experience any suspected side effects from Trulicity, report them via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Frequently Asked Questions