Welcome to the weekly ZIP - your Zenith Informed Pregnancy!
Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research.
This week's top pregnancy questions:
1️⃣ Are GLP-1s okay while trying to conceive?
2️⃣ Can I have chai or matcha?
3️⃣ Is there any safe amount of drinking during pregnancy?
Are GLP-1s okay while trying to conceive?
GLP-1 drugs (think Ozempic, Wegovy, Zepbound and the likes) are everywhere right now, especially after Serena Williams endorsed them and shared her story using them for postpartum weight loss. More women are taking these medications than ever, and not just for weight loss – leading to tons of questions about what happens if you're on a GLP-1 while trying to get pregnant or in early pregnancy.
📚The tl;dr from the evidence: GLP-1s are not recommended for or approved for use during pregnancy, and we don’t (yet!) have much evidence to go on in terms of prospective, human studies. This is a classic case of “we don’t have great data,” and guidance is based on caution, rather than proven risk of harm.
Most of the data we can look at comes from animal studies, which show potential risks such as reduced fetal growth and skeletal changes, although some small recent studies and case reports have not shown a clear increase in adverse pregnancy outcomes or birth defects.
Current guidelines suggest stopping GLP-1 use about 1-2 months before trying to conceive, and that timeline is based on the half-life of the drug – aka how long it will take for the drug to be fully cleared from your system to avoid an early pregnancy exposure to the developing baby.
👀Read Penny’s full summary of the evidence for more on GLP-1s while TTC
Can I have chai or matcha?
Fall is here and with it comes the craving for a cozy drink – searches about both chai tea and matcha spiked this past week. Fear not: both drinks are safe (in reasonable moderation), so as long as you’re not going overboard (think… more than 4 matchas per day overboard…), you can celebrate the autumnal equinox and official start of fall this Monday with a warm tea treat!
📚The tl;dr from the evidence: The primary consideration for both matcha and chai teas is simply caffeine intake. While both teas do contain caffeine, a typical serving of each (ranging from ~40-80mg per cup, depending on the preparation) is still well below the generally accepted guideline from leading organizations like the WHO and ACOG of 200 mg daily.
👀Read Penny’s full summary of the evidence for more on chai & matcha lattes
Is there any safe amount of alcohol during pregnancy?
Most people put alcohol at #1 on the "off-limits" list during pregnancy. September is Fetal Alcohol Spectrum Disorder (FASD) Awareness Month, and while research clearly shows alcohol can cause serious harm, you’ve probably also seen the online anecdotes or suggestions that 'light drinking' or ‘a glass of wine here and there’ might be okay, and ~14% of pregnant people in the US still report having a drink in the past month. So what does the data actually say?
📚The tl;dr from the evidence: No known safe amount exists, and all types of alcoholic beverages carry the same risks (beer, wine, liquor or cocktails). The data showing that alcohol use during pregnancy is associated with increased risk of both adverse pregnancy outcomes and FASDs in children is very robust.
The tricky part is that most studies are based on heavy exposure, and there's limited research specifically on smaller amounts. That doesn't mean light drinking is safe, just that we don't have enough data to pinpoint exact risk levels.
We’ll likely never have an answer to the exact “safe” threshold, because randomized controlled trials (where some women would be randomly assigned to drink alcohol) aren’t ethical given the known potential harms. Observational studies are possible, but have major flaws around the characteristics of alcohol exposure – it's hard to measure objectively (not every "drink" equals one standard drink), people might not report exposure accurately due to fear of judgment, people might forget details about when/what/how much they drank, and even who chooses to participate (or not) in this type of study could skew results.
So while the evidence doesn’t perfectly represent every possible exposure level, clinical guidelines are consistent in recommending that pregnant women abstain from alcohol altogether.
👀Read Penny’s full summary of the evidence for more on alcohol exposure and FASD
🤓 Zenith's top read of the week
Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!
Tylenol in pregnancy: a question of safety or control? (Christine Henneberg, STAT First Opinion) - Lots of great opinion pieces have emerged in response to the ongoing headlines about certain pregnancy exposures supposedly increasing autism risk (with dubious evidence), and we particularly enjoyed this one in STAT.
Dr. Henneberg’s piece argues that we should be asking whether fetal safety is the only measure of whether or not a drug is “okay” during pregnancy - or if we must also consider wellbeing of the mother as a priority, and stop the paternalistic, fear-mongery undertones that often come up like “Better just to tough it out. For the safety of your baby, your suffering is worth it.”
How to do that? She suggests real facts, more research, trust and empowerment for pregnant moms – understanding the actual likelihood of benefit or harm (in numbers!) which can only be achieved with better data, and empowering moms to use their own personal values and risk tolerance to guide their choices. At Zenith, we couldn’t agree more on both counts!
Key excerpt:
“As a doctor and a mother, as much as I hope for more answers about what causes autism, the most important question for me is this: How can I treat pregnant women as fully autonomous, capable adults who can make their own informed and reasonable decisions? No matter what the new HHS report says about Tylenol, my answer to this question won’t change."