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If you are four weeks into semaglutide with no weight loss , multiple factors could be at play

CircHIPK3 is one of the most abundant circRNAs in -cells and regulates hyperglycemia and IR by sequestering miR-124-3p and miR-338-3p, thereby increasing mRNA expression of key -cell genes (e.g., Slc2a2 , Akt1 , and Mtpn ), insulin secretion, and -cell proliferation

Major medical and endocrine societies recommend stopping GLP-1 medications before pregnancy and using other diabetes or weight-management strategies that are known to be safer in pregnancy when needed

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Pathophysiologically, MASLD is strongly associated with insulin resistance, leading to hepatic lipid accumulation, inflammation, and in advanced stages, fibrosis and cirrhosis