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Triple Stop Pre-Conception ARB SGLT2i Statin — ESENeph MCQ

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ModeratePregnancy & RenalTriple Stop Pre-Conception ARB SGLT2i StatinESENeph

A 29-year-old woman with CKD G3a (eGFR 52 mL/min/1.73m2) and IgA nephropathy wishes to become pregnant. She is on losartan 100 mg, dapagliflozin 10 mg, and atorvastatin 20 mg. Her proteinuria is well controlled (uPCR 40 mg/mmol). What is the recommended timeline for stopping her medications before conception?

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Correct answer: C — Stop losartan, dapagliflozin, and atorvastatin at least 4-6 weeks before planned conception

All three medications must be stopped before conception: (1) Losartan (ARB) — teratogenic, causing renal agenesis, oligohydramnios, and skeletal defects; (2) Dapagliflozin (SGLT2i) — animal studies show renal developmental toxicity; not recommended in pregnancy; (3) Atorvastatin — teratogenic (CNS and limb defects), category X. They should be stopped at least 4-6 weeks before planned conception to ensure washout. Labetalol or nifedipine MR can replace losartan for BP control. Proteinuria should be monitored closely as it may worsen without RASi. Low-dose aspirin from 12 weeks for pre-eclampsia prevention is also indicated. Pre-conception counselling should include discussion of CKD progression risk in pregnancy.

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