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Diabetic nephropathy in pregnancy planning — SCE Endocrinology MCQ

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HardDiabetes complicationsDiabetic nephropathy in pregnancy planningSCE Endocrinology

A 42-year-old woman with type 1 diabetes has persistent albuminuria and wants pregnancy. She takes ramipril and atorvastatin. HbA1c is 52 mmol/mol and blood pressure is 122/74 mmHg. What is the most appropriate management before conception?

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

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Correct answer: D — Stop ACE inhibitor and statin with specialist substitution for blood pressure control if needed

Stop ACE inhibitor and statin with specialist substitution for blood pressure control if needed is best because ACE inhibitors and statins should be stopped before pregnancy, while renal and blood pressure risks are managed with specialist alternatives. The alternatives are less appropriate because ramipril and atorvastatin carry fetal risk; spironolactone is unsuitable; SGLT2 inhibitors are not pregnancy substitutes for renal protection. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG3; NICE NG17