Pharmacological management of obesity in women during preconception care
DOI: 10.32364/2225-2282-2026-3-5
Pharmacological management of obesity in women during preconception care
T.N. Markova1,2, L.S. Subbotina1, K.N. Markova1
Luisa S. Subbotina, e-mail: pavlik_l@list.ru
1Russian University of Medicine, Moscow
2Moscow City Clinical Hospital No. 52, Moscow
Obesity has reached pandemic proportions, significantly compromising female reproductive health by reducing fertility, disrupting ovulatory cycles, and impairing oocyte quality while increasing obstetric complications. Although weight reduction during the preconception period is an established strategy for enhancing reproductive outcomes, the safety profiles and optimal administration protocols for high-efficacy pharmacotherapies, in particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs), remain poorly defined for women planning pregnancy. This review evaluates current clinical evidence regarding the use of orlistat, sibutramine, and incretin-based therapies (liraglutide, semaglutide, and tirzepatide) for weight management in the pre-pregnancy phase. While orlistat offers modest weight loss, its utility is hindered by fat-soluble vitamin malabsorption and inconsistent reproductive data. Sibutramine is restricted by cardiovascular concerns and potential teratogenicity, requiring careful selection and timely cessation prior to conception. GLP-1 RAs demonstrate the greatest clinical potential, effectively promoting weight loss, restoring endocrine balance, and improving ovulatory function, especially in polycystic ovary syndrome (PCOS). Although preclinical data suggests a class-wide teratogenic risk for incretins, human follow-up studies involving inadvertent early pregnancy exposure have not demonstrated a significant increase in major congenital anomalies. Nevertheless, strict discontinuation of these agents before conception is mandatory. Robust large-scale trials are essential to establish standardized clinical protocols for pharmacological preconception care in obese women.
Keywords: obesity, preconception care, fertility, orlistat, sibutramine, GLP-1 receptor agonists, liraglutide, semaglutide, tirzepatide.
For citation: Markova T.N., Subbotina L.S., Markova K.N. Pharmacological management of obesity in women during preconception care. RMJ. 2026;3:30–36. DOI: 10.32364/2225-2282-2026-3-5
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