Wegovy, Zepbound, Saxenda, Qsymia and pregnancy or breastfeeding: what the labels say

This is one of the questions I see asked most often and answered worst. So I did the boring thing. I read the FDA label for all seven approved weight loss drugs. Then I pulled out exactly what each one says about pregnancy, breastfeeding and contraception.

Nothing below is my interpretation. Every statement is what the manufacturer’s own FDA-approved prescribing information says. Each one carries the label revision date, and links to every label sit in the sources at the bottom. Labels are the most conservative and most binding statements that exist about a drug. They are what the FDA has agreed the company may claim.

One thing this guide is not: advice about your own situation. If any of this applies to you, the conversation belongs with your prescriber. They can see the rest of your history. This is here so you can walk into that conversation knowing what the paperwork actually says.

The sentence almost every label shares

Read the pregnancy sections back to back and one line keeps reappearing, nearly word for word. The wording barely shifts from label to label. Zepbound’s label (revised 8/2026) puts it as: “Weight loss offers no benefit to a pregnant patient and may cause fetal harm. Advise pregnant patients that weight loss is not recommended during pregnancy and to discontinue ZEPBOUND when a pregnancy is recognized.”

Foundayo (revised 7/2026) says: “Weight loss offers no benefit to a pregnant patient and may cause fetal harm. When a pregnancy is recognized, advise the pregnant patient of the risk to a fetus and discontinue FOUNDAYO.” Contrave (revised 11/2025) opens its risk summary with the same first sentence. Saxenda (revised 6/2026) uses it too. It adds that the drug “should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus”.

The labels state the logic behind the shared wording plainly. These drugs are approved to cause weight loss, and pregnancy is a state in which weight gain is expected. Xenical’s label (revised 7/2024) spells it out: “A minimum weight gain, and no weight loss, is currently recommended for all pregnant women, including those who are already overweight or obese, due to the obligatory weight gain that occurs in maternal tissues during pregnancy.”

Wegovy: the two-month rule, and a split on breastfeeding

Wegovy (semaglutide) is the only one of the seven with a stated waiting period before a planned pregnancy. Section 8.3 says: “Because of the potential for fetal harm, discontinue WEGOVY in patients at least 2 months before they plan to become pregnant to account for the long half-life of semaglutide.” That is a point about how long the drug lingers, not a caution about the pregnancy itself. Semaglutide stays in the body a long time after the last dose. That is what the label’s “long half-life” means.

On pregnancy, section 8.1 says: “When a pregnancy is recognized, advise the pregnant patient of the risk to a fetus. Discontinue WEGOVY in pregnant patients who are using it for weight reduction.” Novo Nordisk also runs a pregnancy exposure registry. The label says it “monitors pregnancy outcomes in women exposed to WEGOVY during pregnancy”.

Breastfeeding is where the injection and the pill part company. It is worth knowing, because the two are often discussed as one drug. For the tablets, the label says: “advise patients that breastfeeding is not recommended during treatment with WEGOVY tablets.” The reason given is SNAC, the absorption enhancer in the tablet. The label also points to the possibility that it builds up in infants. For the injection, the label simply records an absence of data: “There are no data on the presence of subcutaneously administered semaglutide or its metabolites in human milk”. Subcutaneously there means under the skin. The label also notes that the injection “does not contain the SNAC metabolites”. The section then closes, for both forms, with the standard formula: benefits of breastfeeding weighed against “the mother’s clinical need for WEGOVY”. If you are weighing the pill against the injection, this is a real difference between them.

Zepbound: the birth control interaction

Zepbound (tirzepatide) carries the contraception point that surprises people most. Delayed gastric emptying means the stomach empties more slowly, so a swallowed pill can be absorbed differently. Section 8.3 states: “Use of ZEPBOUND may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying. This delay is largest after the first dose and diminishes over time. Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation.”

Section 7.2 adds the reassuring half of that: “Hormonal contraceptives that are not administered orally should not be affected.” So the concern is specifically the pill. And specifically the weeks after starting, and after each dose increase. On a standard dose-raising schedule, which doctors call titration, that is a lot of weeks.

On breastfeeding, the Zepbound label reports a measurement rather than a blanket statement: “In a single-dose clinical lactation study, the concentration of tirzepatide in breast milk was found to be either undetectable or low compared to the maternal administered dose.” It then applies the usual benefits-versus-need framing. Lilly also runs a pregnancy exposure registry for the drug, which records what happens in pregnancies where it was used.

Foundayo: 30 days, and a clear line on nursing

Foundayo (orforglipron) gives the same contraceptive advice as Zepbound, but with a longer window and an honest caveat about why. Section 8.3: “The effect of FOUNDAYO on the absorption of oral contraceptives has not been evaluated in a clinical trial. Because delayed gastric emptying may affect the absorption of oral medications, advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 30 days after initiation with FOUNDAYO and for 30 days after each dose escalation.” The same section advises “women of childbearing potential to use effective contraception during treatment”.

On breastfeeding, Foundayo is more direct than the injectables: “FOUNDAYO is not recommended for nursing women.” The label explains that orforglipron “was present in the milk of lactating rats”. It adds that “when a drug is present in animal milk, it is likely that the drug will be present in human milk”.

Saxenda: the older label, the older format

Saxenda (liraglutide) has no section 8.3 at all. So there is no waiting period before a planned pregnancy and no contraceptive advice anywhere in the label. Section 8.1 says the drug “should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus”. It also says that “when a pregnancy is recognized, advise the pregnant patient of the risk to a fetus, and discontinue SAXENDA”.

On breastfeeding the label is a blank: “There are no data on the presence of liraglutide in human milk, the effects on the breastfed infant, or effects on milk production.” The label notes that in rats, liraglutide appeared in milk. The level was roughly half that found in the mother’s blood.

Qsymia: the strictest label of the seven

Qsymia (phentermine/topiramate) is in a different category. Its section 4 lists patients “who are pregnant” first among the contraindications. A contraindication is not a caution. It is an outright bar.

Section 5.1 explains why: “QSYMIA can cause fetal harm. Data from pregnancy registries and epidemiologic studies indicate that a fetus exposed to topiramate in the first trimester of pregnancy has an increased risk of major congenital malformations, including but not limited to cleft lip and/or cleft palate (oral clefts), and of being small for gestational age (SGA).” Major congenital malformations means serious birth defects present at birth. The same section goes on: “A negative pregnancy test is recommended before initiating QSYMIA treatment in patients who can become pregnant and monthly during QSYMIA therapy.” Section 8.3 repeats the monthly testing point and advises effective contraception throughout.

That risk also drives how the drug is handed out. Only some pharmacies can supply it. The label states: “Because of the teratogenic risk associated with QSYMIA therapy, QSYMIA is available through a limited program under the REMS. Under the QSYMIA REMS, only certified pharmacies may distribute QSYMIA.” Teratogenic means able to harm a developing baby. A REMS is a Risk Evaluation and Mitigation Strategy: an FDA-mandated safety programme that restricts how a drug reaches patients. Of the seven approved drugs, this is the only one with one attached for pregnancy risk.

On breastfeeding, the label says to “advise patients that breastfeeding is not recommended during QSYMIA therapy”. And on birth control specifically, the label notes that in patients taking combined oral contraceptives, Qsymia “may cause irregular bleeding”. It adds: “Advise patients not to discontinue taking their COC and to contact their health care provider.” A COC is a combined oral contraceptive pill. Spotting is not a sign the contraceptive has stopped working. There is more on that in the Qsymia interactions page.

Contrave and orlistat

Contrave (naltrexone/bupropion) follows the standard formula on pregnancy: discontinue when a pregnancy is recognised. It notes that available data with its individual components “have not demonstrated a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes”. On breastfeeding, the label is specific. It says: “Data from published literature report the presence of bupropion and its metabolites in human milk”. It adds that “Naltrexone and its major metabolite, 6β-naltrexol, are present in human milk.” It then applies the benefits-versus-need framing. There is no section 8.3.

Orlistat exists in two forms with two labels. Prescription Xenical is “contraindicated in: Pregnancy”. On nursing it says: “It is not known if XENICAL is present in human milk. Caution should be exercised when XENICAL is administered to a nursing woman.” The over-the-counter version is Alli 60 mg, and its label was updated 18 March 2026. It reduces the whole question to a single line in its Drug Facts warnings: “If pregnant or breast-feeding, do not use.”

If any of this is live for you, the useful next move is a conversation, not more reading. The labels are written for prescribers, and they stop short of telling anyone what to do. Our page on talking to your doctor has questions worth bringing. And the page on stopping treatment covers what the trial data shows about coming off these drugs.