Pharmacological management of obesity in pregnancy: a review of current and emerging therapies

The escalating prevalence of maternal obesity and excess gestational weight gain poses significant risks to both maternal and child health. Current management strategies, primarily focused on lifestyle interventions, often have limited efficacy, creating an urgent unmet clinical need. This review summarises the evidence for pharmacological management of obesity in pregnancy. We systematically searched the literature to evaluate historical and emerging weight management therapies for use in pregnancy. Existing medications such as metformin, orlistat, and naltrexone-bupropion have limited application due to modest efficacy or inconsistent safety data. Newer agents like glucagon-like peptide-1 (GLP-1) receptor agonists are transforming obesity care but are not currently recommended during pregnancy due to insufficient safety information. While animal studies have raised concerns regarding foetal growth, large human observational studies have not yet demonstrated a significant independent risk of major congenital malformations after accounting for confounding maternal comorbidities. Future progress depends on robust, collaborative research, including pregnancy registries, to determine if these agents could have a role in carefully selected, high-risk cases. Clinical guidance continues to support adherence to National Academy of Medicine gestational weight-gain targets, particularly the modest recommended gain for women with obesity.