EO: 203 GLP1s and Pregnancy with Dr. Kerri Brackney

In this episode of Healthy Mom Healthy Baby Tennessee, Dr. Linley Wolfe interviews Dr. Carrie Brackney, a maternal-fetal medicine physician in Memphis, about GLP-1 receptor agonist medications (commonly known as Ozempic, Wegovy, and similar drugs) and their implications for pregnancy. The discussion covers how these medications work, their dramatic effects on weight loss and diabetes management, and the emerging phenomenon of "Ozempic babies" - unintended pregnancies occurring in women taking these medications. Dr. Brackney provides guidance on when to discontinue these medications before conception, discusses limited safety data in pregnancy, and explains what monitoring is recommended for women who become pregnant while taking GLP-1s. Both physicians share their personal experiences with these medications and express hope for future research on postpartum use.Episode Highlights00:00:04: Welcome to Healthy Mom, Healthy Baby Tennessee podcast, brought to you by the Tennessee Initiative for Perinatal Quality Care (TIPQC), which exists to improve health outcomes for mothers and infants in Tennessee 00:00:46: Dr. Linley Wolfe introduces Dr. Carrie Brackney, a maternal-fetal medicine physician in Memphis who has been practicing as a perinatologist for three years after working as a general OB-GYN for nine years00:01:32: Dr. Brackney describes her passion for caring for women with complex pregnancies and helping them find joy during challenging times00:02:03: Dr. Wolfe introduces the topic of GLP-1 medications, noting they have been revolutionary for people struggling with weight00:02:38: Dr. Brackney explains that GLP-1 receptor agonists work by activating glucagon-like peptide one receptors, regulating blood sugar, reducing appetite, and slowing digestion through multiple mechanisms00:03:46: Discussion of how GLP-1 medications have been around for diabetes treatment but have been increasingly used for weight loss over the last four to five years00:04:04: Dr. Brackney notes these medications are also being used for patients with cardiovascular conditions and kidney disease, showing decreased complications00:04:28: Dr. Wolfe mentions recent approval for people who are overweight with sleep apnea, predicting more indications will emerge00:04:42: Cost identified as one of the biggest barriers to these medications becoming more popular00:05:01: Dr. Brackney reports that semaglutide and tirzepatide show potential for over 10% weight loss, while liraglutide shows 5-15% total weight loss00:05:49: Discussion of side effects, with nausea and constipation being the most common, though they are treatable and many people adjust over time00:06:09: Dr. Wolfe asks about common brand names versus generic names for listener clarity00:06:25: Dr. Brackney lists brand names including Ozempic, Wegovy, Rybelsus (semaglutide), Trulicity (dulaglutide), Victoza and Saxenda (liraglutide), and Mounjaro (tirzepatide)00:07:02: Discussion of compounded medications versus manufacturer medications, with Dr. Brackney noting compounded versions are not FDA-regulated and therefore not considered as safe00:07:55: Dr. Wolfe transitions to discussing pregnancy and the phenomenon of "Ozempic babies"00:08:51: Dr. Brackney explains that obesity reduces fertility, with obese women having three times higher risk of infertility and 40% higher miscarriage rates00:10:28: Discussion of how GLP-1 medications may interfere with contraceptive distribution in the body due to slowed gastric emptying00:11:04: Dr. Wolfe summarizes that better overall health, weight loss, and potential contraceptive interference all contribute to "Ozempic babies"00:11:27: Dr. Brackney recommends discontinuing GLP-1 medications at least one to two months before trying to get pregnant, noting limited data on ideal timing00:12:38: Discussion of the lack of prospective studies on pregnant women, with only retrospective data and animal studies available00:13:22: Dr. Brackney describes animal studies showing lower fetal growth and delayed bone ossification in offspring of rats and rabbits given tirzepatide00:14:29: Comparison made to bariatric surgery patients, where rapid weight loss during pregnancy led to worse outcomes including growth restriction and birth defects00:15:14: Dr. Wolfe shares her partner's interesting theory about potential future use for excessive weight gain during pregnancy00:15:50: Dr. Brackney expresses interest in studying postpartum use, particularly during the 12-month Medicaid coverage period in Tennessee00:16:29: Both physicians disclose they are personal users of GLP-1 medications, with Dr. Wolfe noting they have been life-changing for her00:16:56: Discussion of rebound weight gain as a concern when stopping medications suddenly00:18:28: Dr. Wolfe shares a recent case of balancing when to stop medication in a patient with multiple comorbidities planning pregnancy00:19:58: Dr. Brackney suggests metformin as a potential alternative to prevent rebound weight gain while being better studied in pregnancy00:20:32: Discussion of what to tell patients who discover pregnancy while still taking GLP-1 medications00:21:03: Dr. Brackney provides reassurance that data thus far is pretty reassuring with no worrisome issues seen in early pregnancy exposures00:22:12: Discussion of long-term data limitations, with mention of thyroid cancer risk being very low and primarily in already high-risk patients00:23:38: Dr. Wolfe asks about pregnancy management for women who have been taking GLP-1 medications00:24:05: Dr. Brackney outlines comprehensive pregnancy monitoring recommendations including early ultrasound, anatomy survey, and specialized care based on underlying indication00:25:55: Dr. Wolfe concludes by noting the goal of a perfectly healthy pregnancy and beautiful vaginal delivery for these patients00:26:24: Dr. Brackney thanks TIPQC and expresses enjoyment of the discussion00:26:39: Closing remarks encouraging listeners to visit tipqc.org for podcast suggestions and to follow on social media for perinatal health news in TennesseeKey TakeawaysGLP-1 medications work through multiple mechanisms including regulating blood sugar, reducing appetite, and slowing digestion, making them effective for both diabetes and weight loss management Women taking GLP-1 medications should discontinue them at least one to two months before attempting pregnancy, though data on optimal timing is limitedThe "Ozempic baby" phenomenon occurs due to improved fertility from weight loss, better overall health, and potential interference with contraceptive effectivenessCurrent data on GLP-1 use in pregnancy is limited to retrospective studies and animal research, with animal studies showing concerns about fetal growth restriction and skeletal developmentWomen who become pregnant while taking GLP-1 medications should receive reassurance that current data is relatively reassuring, but should have comprehensive monitoring including early ultrasound and anatomy surveyRebound weight gain after stopping GLP-1 medications is a concern, with studies showing 62% of women who stopped at pregnancy onset experienced excess gestational weight gainFor women with diabetes taking GLP-1s, switching to pregnancy-safe alternatives like metformin before conception is important to maintain glycemic control and prevent birth defectsThe postpartum period may represent an ideal opportunity for GLP-1 use and research, particularly during the 12-month Medicaid coverage period in TennesseeCost remains one of the biggest barriers to GLP-1 medication access, though they show significant benefits for obesity, diabetes, cardiovascular disease, and kidney diseaseCompounded GLP-1 medications are not FDA-regulated and therefore not recommended over manufacturer versions despite cost considerationsQuotable Moments"I really love some of the detective work that goes into caring for these conditions and figuring out what's going on. But I especially enjoy helping women to find joy during the challenges that they face throughout their pregnancies.""I think these medicines are going to become more and more popular, especially as they become more affordable because right now I think one of the biggest barriers is their cost.""Women who are obese have a three times higher risk of infertility and they have a much higher risk of stillbirth or miscarriage. Miscarriage rates go up by about 40% for women who are obese.""I recommend to my patients that they discontinue GLP one receptor antagonists at least a month or two before trying to get pregnant. And I'll be honest, there's not great data to say one way or another what the ideal timing is.""Full disclosure, I too have been taking these medications now I'm really in like the weight maintenance phase. But yeah, I mean I think they're really, really helpful as a tool for a lot of folks.""I think overall the data thus far is pretty reassuring. When we look at the folks who were exposed early in pregnancy, we haven't seen any really worrisome issues.""I think it remains to be seen, but to me, first you have to prove to me that whatever, whatever risks there are, are worse than all those things. Because certainly those are significant risks to people.""I do wonder if maybe there's an opportunity to do some studies for weight management or even diabetes management in, in postpartum moms, particularly in that first year after they deliver."Show Notes by BarevalueNo content or comments made in any TIPQC Healthy Mom Healthy Baby Podcast is intended to be comprehensive or medical...