"Oops babies", they're called. The unplanned pregnancies that seem to be catching hundreds of women by surprise, that occur after they take Ozempic — and other drugs like it — to curb their appetites and lose weight.
Ozempic, initially prescribed for type 2 diabetes, is blasting its way around the world on the fuel of extraordinary hype as celebrities who take it seem to shrink before our eyes, limbs narrowing, faces sinking, profiles sharpening. Now, millions are racing to get prescriptions, and experts have begun to calculate the global impact of a possibly widespread reduction in rates of obesity.
It appears to be astonishingly effective, and hugely lucrative for commercial backers.
But the side effects aren't fully known yet — although there has been some discussion of nausea, stomach pain, hair loss and a drawn, thinner "Ozempic face".
Now, the discovery of these pregnancies, as evidenced in Facebook groups like "I got pregnant on Ozempic", Reddit threads and anecdotal stories from doctors, has caused some alarm.
The prospect of unexpected pregnancy is both delightful — for those who have struggled with their fertility and longed for a baby — and extremely troubling, for those who don't want kids. The real problems lie in the complete lack of data about what happens if you take these drugs before and during conception, and what the impact on the fetus might be. Then there's the prospect of ineffective contraception.
'We're moving forward without all the data'
Why worry? Well, animal studies have found that if mice and rats get high doses of these weight loss drugs — which contain semaglutide, which makes a hormone called GLP-1 work better — their babies are born small, have malformations, and are more likely to die. The mother rodents have less appetite, eat less and fewer nutrients go to the fetus.
One study found the drugs can slash the number of proteins that carry nutrients from mother to child. Which is… sobering. In rabbits and cynomolgus monkeys, mothers were thinner, more likely to miscarry and fetuses featured more abnormalities.
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Responding to these concerns in a statement, a spokesperson for Ozempic manufacturer Novo Nordisk admitted that there isn't enough data to know the risk for birth defects or miscarriage but that, indeed, animal tests show that there "may be potential risks to the fetus from exposure to semaglutide during pregnancy".
Some experts believe Ozempic drugs could cause women with polycsystic ovary syndrome (PCOS) to ovulate, resetting the body with weight loss, better insulin resistance and more balanced hormones. PCOS is a common cause of infertility, which is more likely to be seen in women with obesity. But the companies have no plans to study this.
Melanie Cree, director of the PCOS Clinic at Children's Hospital Colorado declared that Ozempic babies were "happening all over the place", which was very exciting, she said, but it's "a bit scary because we're moving forward without all the data".
Women are unwitting guinea pigs
A bit scary? This would not be the first time in history that we have leapt upon a sparkling new remedy for various physical ills, guzzling, popping or layering it upon our bodies without understanding its potential side effects.
We don't even know if it passes into human breast milk — though it seems to be present in the milk of lactating rat mothers who take it, which should provide pause.
But the finding that a significant number of women have fallen pregnant on these drugs — and that a growing number of doctors are citing ovulation as a side effect — has gobsmacked me. Not because, whilst slowly slimming, women are finding themselves suddenly fertile, but because yet again, for the umpteenth time, the manufacturers of a wildly popular drug, taken by millions of women globally, have not collected data on what this drug might do to a woman's reproductive organs, or offspring.
And now we hear of 53-year-olds suddenly conceiving twins.
Dr Andrea Shields, the vice chair of the American College of Obstetricians and Gynecologists' committee on clinical guidelines for obstetric care told the New York Times that, until more research is conducted on humans, "we're all just kind of holding our breath".
It was once believed that medications could not pass from mother to child, a myth spectacularly exploded by the widespread taking of thalidomide — prescribed for morning sickness, insomnia, colds and headaches — which resulted in many thousands of infant deaths and disability (in the 1950s the toxicity of thalidomide was tested on animals, but not pregnant women).
The enduring and understandable reluctance to conduct tests on pregnant women today — although experts say with careful protocol design it can, should and has been done — means that trials effectively occur once the drugs are out and pregnant women are taking them.
They are, unwittingly, guinea pigs.
Where are the guardrails of research?
I don't want to be alarmist. One preliminary study found "initial reassurance", concluding that women with type 2 diabetes who were taking weight loss drugs at and after conception had no greater risk of having babies with major congenital malformations than those who had insulin. Although another study urged the collection of more data.
But we have good reason to be sceptical of the pharmaceutical industry's lack of research into, knowledge of, and care for women's bodies.
The rub is it makes sense for many women to take these drugs before having a baby. Doctors advise women with obesity to shed excess weight before pregnancy to regulate hormones — and because weight can heighten risk of miscarriage and add to pregnancy complications.
What's amazing is that in the United States, the behaviour of pregnant women is monitored so closely. They have signs posted in bars telling staff not to serve wine to pregnant women. It seems almost cavalier to let these drugs be so widely consumed without the guardrails of research.
And in a land where, after the overturning of Roe v Wade by the Supreme Court, the march to narrow women's reproductive rights has gathered momentum and attention, it seems especially odd that these drugs can be given so much commercial and cultural cache without knowing exactly how they interact with different contraceptives.
Some of these drugs reduce the effectiveness and absorption of birth control pills, but, as CNN reports, while "Mounjaro and Zepbound warn about this explicitly on their labels, Ozempic and Wegovy only warn more broadly about absorption of any drugs taken by mouth". (The Therapeutic Goods Administration in Australia recommends taking an additional form of contraception.)
And there are many states in the US where women do not want to be accidentally pregnant.
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Why is the onus always on women to take the risk?
In the absence of data, doctors suggest stopping taking them two months before conception. So women will need to wobble on a tightrope between losing weight in order to get pregnant, and potentially hurting a fetus.
But what about the women who take it without knowing they're pregnant? Why is the onus always on women to take the risk?
We are not machines, and our reproductive cycles can be highly idiosyncratic — pregnancies can be accidental and unplanned at the best of times.
At best it would be ill advised to, while clamping down on women's reproductive rights, provide research on the impact of one of the most high-profile, popular new medications on women's bodies, babies and futures.
Companies have begun pulling in information on these "accidents", but we urgently need data collection to continue, and the speedy release of their findings.
Julia Baird is co-host of the ABC podcast Not Stupid, which can be found on the ABC Listen app.
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