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Obesity Management During Reproductive Years
Clinical Queries: Expert Insights to Improve Obesity Management During Reproductive Years 

Released: January 20, 2026

Celia Egan
Celia Egan, MD, MSCP, DABOM
Kimberley Sampson-Paine
Kimberley Sampson-Paine, MD, MSc, FACOG, DipABLM, DipABOM, MSCP, FOMA
Samantha B. Schon
Samantha B. Schon, MD, MSTR
Activity Information

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Case Conclusion
Leah lost 8% of her initial bodyweight and reached a BMI of 31.9 kg/m2 before her first pregnancy at 30 years of age. She then gained 35 lb (16 kg) while pregnant and, when she stopped breastfeeding 6 months after delivery, she still was 25 lb (11 kg) above her prepregnancy weight. Leah was also diagnosed with weight-related comorbidities (eg, metabolic syndrome and OSA) in addition to her preexisting PCOS. She and her partner wanted to try conceiving again in 1-2 years, and Leah wanted to lose 25 lb (11 kg) before then to reach her prepregnancy weight and potentially improve her chances of conceiving. After discussing her options with you, Leah decided to start tirzepatide. After 9 months, she reached her weight loss goal and, after talking with you, decided to focus on lifestyle modifications and discontinue tirzepatide 2 months before trying to conceive. She later conceived her second baby 4 months after stopping tirzepatide. Leah regained approximately 3 lb (1.5 kg) while trying to conceive but she attributed strict adherence to intensive lifestyle modifications to helping her maintain most of her weight loss. She continued her lifestyle management regimen during pregnancy, and her OB/GYN HCP did not identify anything unusual during the first ultrasound. By the end of her first trimester, Leah gained 5 lb (2 kg)—slightly more than the recommended 1-4 lb (0.5-2.0 kg)—and she generally is on track with weight gain targets during pregnancy.

Discussion Summary
During interpregnancy intervals, OB/GYN HCPs have opportunities to address the complications and health issues that arise during pregnancy, optimize patients’ overall health before subsequent pregnancies, and contribute to long-term health. This is key because prepregnancy obesity is associated with increased risks for multiple conditions like infertility, gestational diabetes, hypertensive disorders, cesarean delivery, large-for-gestational age neonates, and birth defects, and postpartum weight retention contributes to obesity and higher metabolic risk. Therefore,  losing weight during interpregnancy intervals can improve maternal and fetal outcomes. Recommendations encourage women to achieve their prepregnancy weight by 1 year postpartum and before any future pregnancies. However, in some situations, such as for women who may be facing time constraints due to fertility loss with aging, decisions might be made to prioritize conception attempts over weight loss.1-3

Lifestyle modifications are the foundation of obesity management, but anticipated weight loss with these strategies alone is generally modest (5%-10%).4 MBS offers the greatest and most durable weight loss but is associated with surgical risks and potential nutritional deficiencies. In addition, the timing of MBS is an important consideration, as it is recommended that women delay pregnancy for a 1-2 years after surgery.5,6 Therefore, MBS may not be a feasible option for women who wish to conceive sooner.

If patients cannot achieve significant weight loss with lifestyle modifications alone, AOMs should be considered in those with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) and at least 1 weight-related comorbidity.3 It is noteworthy that second-generation AOMs (ie, GLP-1 and dual GIP/GLP-1 receptor agonists) are associated with 15% to 23% weight loss and improved weight-related comorbidities.2 In a head-to-head clinical trial, tirzepatide demonstrated significantly greater weight loss (20.2%) vs semaglutide (13.7%) at 72 weeks.7 In addition, semaglutide is approved to reduce the risk of major adverse cardiovascular events in those with established cardiovascular disease and to treat noncirrhotic metabolic dysfunction–associated steatohepatitis with moderate to advanced liver fibrosis; tirzepatide is approved to treat moderate to severe OSA.8,9 These additional indications should be considered, as HCPs and/or patients may prefer an AOM that is approved to treat patients’ obesity and additional weight-related comorbidities. 

HCPs and patients also should be aware that AOMs are generally not recommended when patients are actively trying to conceive or during pregnancy.10 In addition, certain AOMs have specific contraception and discontinuation recommendations. For example, those receiving phentermine/topiramate should be advised to use effective contraception because of the known teratogenicity of topiramate.11 Furthermore, because of its long half-life (1 week), semaglutide should be stopped 2 months before attempting to conceive. Although US prescribing information for tirzepatide does not specify discontinuation timing, it is reasonable to stop tirzepatide 1 month before conception attempts, based on a half-life of 5-6 days. It is worth noting that tirzepatide product information in Canada and Europe recommends discontinuation 1 month before attempting conception.12,13

With this in mind, weight regain is common after AOM discontinuation, which may contribute to excess weight gain during pregnancy.14 HCPs should counsel patients that this is a consequence of obesity as a chronic disease and help them identify approaches to mitigate weight regain. In particular, strict adherence to lifestyle modifications has been associated with weight maintenance after AOM discontinuation and can be used during conception and pregnancy.2