Examining the Trade-off of Breastfeeding vs. Semaglutide Use After Childbirth
Author(s)
Surrey M. Walton, PhD1, Kaytlin Krutsch, PhD, PharmD, MBA, BCPS2, Shraddha Trehan, BS3, Emma Schmidt, BA3, Tricia J. Johnson, MA, PhD4.
1Department of Pharmacy Systems Outcomes and Policy, University of Illinois-Chicago, Chicago, IL, USA, 2Infant RiskCenter and School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA, 3School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA, 4Professor, Rush University, Chicago, IL, USA.
1Department of Pharmacy Systems Outcomes and Policy, University of Illinois-Chicago, Chicago, IL, USA, 2Infant RiskCenter and School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA, 3School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA, 4Professor, Rush University, Chicago, IL, USA.
Presentation Documents
OBJECTIVES: Nearly 50% of pregnant women in the US have overweight or obesity and often seek postpartum weight management interventions. GLP-1 agonists like semaglutide (Ozempic, Wegovy) are highly effective for weight loss and have gained significant media attention, increasing demand for these medications. The World Health Organization and American Academy of Pediatrics recommend breastfeeding for two years postpartum, while FDA-approved labeling advises against breastfeeding during semaglutide use. However, no evidence-based assessments exist of the tradeoffs between breastfeeding and taking semaglutide postpartum. Our objective was to assess the health tradeoffs for mothers who breastfeed versus take semaglutide without breastfeeding for two years after childbirth.
METHODS: We reviewed literature on lifetime effects of breastfeeding and semaglutide on health outcomes for mothers with overweight or obesity. We qualitatively compared the incidence of hypertension, diabetes, cardiovascular disease, and myocardial infarction for both interventions and examined additional breastfeeding effects other maternal and child health outcomes.
RESULTS: Semaglutide and breastfeeding have similar cardiometabolic risk reductions. Optimal breastfeeding for 24+ months averts 17,190 - 23,254 cases of diabetes and roughly 9,400 hypertension cases per 100,000 women with overweight or obesity. Semaglutide reduces 19,211 diabetes cases and 8,263 cardiovascular disease cases per 100,000. Breastfeeding additionally reduces breast cancer risk and averts 36 child deaths per 100,000.
CONCLUSIONS: Evidence strongly suggests 24 months breastfeeding confers similar cardiometabolic benefits to lifetime semaglutide use, with additional benefits from preventing child deaths and avoiding adverse drug events. Not breastfeeding is associated with worse health outcomes for mother and infant that is very unlikely to be overcome by immediate postpartum use of semaglutide. A key limitation is that semaglutide evidence is based on data from a broader age range. Additionally, the effect of concomitant breastfeeding and semaglutide treatment is unknown. To maximize health outcomes, we suggest mothers choose breastfeeding over semaglutide in the two years after childbirth.
METHODS: We reviewed literature on lifetime effects of breastfeeding and semaglutide on health outcomes for mothers with overweight or obesity. We qualitatively compared the incidence of hypertension, diabetes, cardiovascular disease, and myocardial infarction for both interventions and examined additional breastfeeding effects other maternal and child health outcomes.
RESULTS: Semaglutide and breastfeeding have similar cardiometabolic risk reductions. Optimal breastfeeding for 24+ months averts 17,190 - 23,254 cases of diabetes and roughly 9,400 hypertension cases per 100,000 women with overweight or obesity. Semaglutide reduces 19,211 diabetes cases and 8,263 cardiovascular disease cases per 100,000. Breastfeeding additionally reduces breast cancer risk and averts 36 child deaths per 100,000.
CONCLUSIONS: Evidence strongly suggests 24 months breastfeeding confers similar cardiometabolic benefits to lifetime semaglutide use, with additional benefits from preventing child deaths and avoiding adverse drug events. Not breastfeeding is associated with worse health outcomes for mother and infant that is very unlikely to be overcome by immediate postpartum use of semaglutide. A key limitation is that semaglutide evidence is based on data from a broader age range. Additionally, the effect of concomitant breastfeeding and semaglutide treatment is unknown. To maximize health outcomes, we suggest mothers choose breastfeeding over semaglutide in the two years after childbirth.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO114
Topic
Clinical Outcomes, Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)