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Pre-Conception Medication Review T1DM CKD — ESENeph MCQ

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EasyPregnancy & RenalPre-Conception Medication Review T1DM CKDESENeph

A 32-year-old woman with type 1 diabetes and CKD G3a (eGFR 50 mL/min/1.73m2, uACR 35 mg/mmol) is planning pregnancy. She is on ramipril 10 mg, atorvastatin 20 mg, insulin glargine, and insulin aspart. Which medication changes are required before conception?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Stop both ramipril and atorvastatin

Both ACE inhibitors and statins are teratogenic and must be stopped before conception. ACEi/ARBs cause renal agenesis, oligohydramnios, and pulmonary hypoplasia (particularly in second/third trimester but risk exists from first trimester). Statins are category X — associated with limb and CNS abnormalities. Antihypertensive alternatives for pregnancy include labetalol, nifedipine MR, or methyldopa. Proteinuria should be monitored closely as removal of RASi may cause deterioration. The patient should be counselled that pregnancy in T1DM with CKD carries increased risk of pre-eclampsia and CKD progression.

Reference: NICE 2019 – NG133 Hypertension in Pregnancy; BNF 2024 – Prescribing in Pregnancy; UKKA 2019 – CKD in Pregnancy