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A U.S. analysis of insurance claims found that the share of women starting GLP-1 medication within six months of delivery rose from 0.08% in early 2018 to 1.9% by early 2025. The increase initially was greatest among women with type 2 diabetes, but most starts in the second half of 2024 were among women outside that group. The study cannot establish why individuals started treatment or assess safety during breastfeeding.
The share of women starting a GLP-1 medication within six months after delivery rose from 0.08% in early 2018 to 1.9% by early 2025, according to a U.S. insurance-claims analysis published in a research letter in JAMA. The increase was largest among women with type 2 diabetes, but by the second half of 2024, most new users did not have that diagnosis, raising questions about prescribing patterns and the limited evidence on postpartum use.
Researchers led by Sih-Ting Cai, PhD, of the University of Southern California analyzed commercial insurance claims for 911,908 women ages 18 to 49, covering 1,104,417 deliveries from January 2018 through March 2025. They counted a postpartum start when a woman had at least one pharmacy claim for a GLP-1 drug within six months of delivery. The overall rate rose more than 20-fold across the study period, from 0.08% to 1.9%.
Among women with type 2 diabetes, initiation rose from 2.3% to 16.9%. But in the second half of 2024, type 2 diabetes accounted for 18.3% of initiators. The largest reported group, 40.4%, had overweight or obesity; 20.7% had no qualifying diagnosis recorded before delivery, and 20.6% had gestational diabetes. These categories describe diagnoses in claims, not necessarily each person’s full clinical history.
Most users did not start immediately after birth: 61.6% began three to six months postpartum. Median time to a first claim was 95 days for women with type 2 diabetes and 117 days for those without a relevant recorded diagnosis. Among initiators with no qualifying pre-delivery diagnosis, 55.2% had a diagnosis recorded between delivery and their first medication claim, most often overweight or obesity.
Postpartum Prescribing Is Broadening
The findings suggest postpartum GLP-1 use is no longer limited mainly to women with a pre-existing type 2 diabetes diagnosis. That matters for clinicians and patients because postpartum care may involve ongoing metabolic risks, while decisions about weight management and medication can also intersect with recovery from birth, breastfeeding and mental health.
The study documents a change in claims, not whether treatment was appropriate, effective or safe for individual patients. Cai told MedPage Today that the clinical need is growing but that safety evidence has not kept pace. The scale of use makes better evidence on who is receiving these drugs, why they are prescribed and what outcomes follow increasingly relevant.
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How Researchers Counted Starts
The analysis used Merative MarketScan Commercial claims and diagnostic codes. Eligible women had continuous insurance enrollment for six months before and after delivery; researchers excluded women with type 1 diabetes and those with a GLP-1 fill during the 180 days before delivery. Diagnoses were identified from claims up to 12 months before birth.
The authors said the U.S. results provide a benchmark comparable to a Danish study published in JAMA the previous year, which found postpartum prescriptions rose after semaglutide was approved for weight loss. The researchers cautioned that differences in healthcare systems make direct comparisons imperfect. GLP-1 drugs are generally not used during pregnancy, and research on use around pregnancy and after birth remains limited.
“Postpartum GLP-1 use is likely rising even faster than our numbers show, while the safety evidence hasn’t kept pace. That gap is worth more attention.”
— Sih-Ting Cai, lead researcher, speaking to MedPage Today
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Safety and Prescribing Reasons Unknown
The analysis cannot show why a clinician prescribed a drug, whether patients filled or took the medication as directed, or whether treatment led to health benefits or harms. Claims-based diagnoses may be incomplete or recorded after delivery; the authors said the later diagnoses among some patients could reflect newly developed or newly documented risk, or incomplete information before birth.
The researchers did not know whether participants were breastfeeding, so the study does not establish safety during lactation. It also cannot fully account for prior use more than 180 days before delivery. Because the sample included only commercially insured women, it may not represent patients with other coverage or those paying out of pocket. The authors noted that cash-pay telehealth prescriptions and compounded formulations may not appear in traditional insurance claims.
Earlier reviews cited by the report found no apparent increase in adverse maternal or perinatal outcomes associated with GLP-1 use around pregnancy, but experts urged caution pending stronger evidence. Those findings do not settle the safety of postpartum use or use while breastfeeding.
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Research to Track Use and Outcomes
Cai said future work should examine what is driving prescriptions among women without a diagnosis recorded before delivery, as well as use through cash-pay telehealth and compounded products. Further studies could also track breastfeeding status, treatment timing and health outcomes, including whether postpartum treatment affects the risk of developing type 2 diabetes after gestational diabetes.
For now, the study offers a benchmark in commercially insured patients through early 2025 rather than a full picture of U.S. use. How prescribing has changed since the data period, and how benefits and risks differ by diagnosis and breastfeeding status, remain open questions.
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Key Questions
How much did postpartum GLP-1 starts increase?
The share of women with a GLP-1 medication claim within six months of delivery increased from 0.08% in early 2018 to 1.9% by early 2025 in the study’s commercially insured population.
Who accounted for most starts in late 2024?
In the second half of 2024, 18.3% of initiators had type 2 diabetes. The study reported 40.4% had overweight or obesity, 20.6% had gestational diabetes and 20.7% had no qualifying pre-delivery diagnosis recorded.
Does the study show GLP-1 drugs are safe while breastfeeding?
No. Researchers could not determine breastfeeding status from the claims data, so the analysis does not establish safety during lactation. Patients should discuss medication decisions with a qualified health professional.
What are the study’s main limitations?
It relied on insurance claims, which may not capture all diagnoses or medication use, and included only commercially insured women. It also could not determine why a drug was prescribed, whether it was taken, or what outcomes followed.
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