Should women with diabetic nephropathy considering pregnancy continue ACE inhibitor or angiotensin II receptor blocker therapy until pregnancy is confirmed?

Excerpt

To the Editor: We read with interest the article by Tennant et al [1], which highlights the increased risk of fetal and infant death in women with pre-existing diabetes. The magnitude of these risks increases with HbA_1c concentrations above 49 mmol/mol, and women with diabetes and a history of retinopathy have twice the incidence of fetal or infant death. The findings of Tennant et al support the need for not only good glycaemic control but also more intensive pre-pregnancy counselling for the women in higher risk categories. Women who have diabetic nephropathy (persistent albuminuria and/or estimated glomerular filtration rate <60 ml min⁻¹ 1.73 m⁻²) are in one of the highest risk groups for adverse maternal and fetal events. In order to improve outcomes, we suggest that ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) should be more widely prescribed for women with diabetic nephropathy who are considering pregnancy, to optimise blood pressure control and reduce proteinuria. …