Dulaglutide
This review examines the available information on dulaglutide, a GLP-1 receptor agonist used for type 2 diabetes management, in the context of breastfeeding safety. The authors note a complete absence of clinical data on dulaglutide use during lactation. They reason that, due to dulaglutide's large molecular weight of approximately 59,669 daltons as a protein molecule, transfer into breast milk is theorized to be minimal. Furthermore, even if trace amounts were present in milk, oral absorption by a nursing infant is considered unlikely because the compound would probably be degraded by proteolytic enzymes in the infant's gastrointestinal tract. Despite this theoretical reassurance, the authors conclude that caution is warranted when considering dulaglutide use during breastfeeding, with heightened concern for newborns and preterm infants, whose gastrointestinal systems may be less capable of fully degrading such compounds. The primary limitation of this review is the total lack of empirical human lactation data, meaning all conclusions are based on pharmacokinetic reasoning and extrapolation rather than direct measurement or clinical observation.