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Pre-Conception Medication Plan CKD — ESENeph MCQ

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EasyPregnancy & RenalPre-Conception Medication Plan CKDESENeph

A 45-year-old woman with CKD G3a on Ramipril is referred for pregnancy counselling. She currently takes Ramipril 10 mg, Dapagliflozin 10 mg, and Atorvastatin 20 mg. What specific pre-conception medication plan is needed?

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Correct answer: E — Stop Ramipril and switch to Labetalol; stop Dapagliflozin (no safety data in pregnancy); stop Atorvastatin (teratogenic) – all changes made before conception or as soon as pregnancy confirmed

Three medications require pre-conception/early pregnancy changes: (1) Ramipril (ACEi) – teratogenic, switch to Labetalol or Nifedipine; (2) Dapagliflozin (SGLT2i) – no human pregnancy safety data, should be stopped; (3) Atorvastatin (statin) – teratogenic, stop without replacement. Ideally all changes should be made pre-conception. Additionally, folate 5 mg daily should be started, low-dose Aspirin from 12 weeks is recommended (CKD is a pre-eclampsia risk factor), and the patient should be under joint nephrology-obstetric care.

Reference: NICE NG133 2019; UKKA 2019 – Pregnancy in CKD; BNF Pregnancy Safety