3
Î 1.7c. ES suggests in the exceptional case where the degree of
renal dysfunction is severe and there is uncertainty about when
conception will occur, physicians and patients be engaged in shared
decision-making about whether to continue ACE inhibitors or ARBs.
These patients should be informed about the possible loss of renal
protective properties if the medication is discontinued and the risk of
teratogenesis if it is continued. (U)
Î 1.7d. ES recommends when ACE inhibitors or ARBs have been
continued up to the time of conception that the medication should be
withdrawn immediately upon the confirmation of pregnancy. (1|⊕⊕
)
Elevated Vascular Risk
Î 1.8a. ES recommends that if a woman with diabetes has sufficient
numbers of vascular risk factors (particularly the duration of the
woman's diabetes and her age), screening studies for CAD be
undertaken in advance of withdrawing contraceptive measures or
otherwise trying to conceive. (1|⊕
)
Î 1.8b. ES recommends if a woman with diabetes is seeking pregnancy
and has CAD, its severity should be ascertained, treatment instituted,
and counseling provided as to the potential risks of pregnancy to
the woman and fetus before the woman withdraws contraception or
otherwise tries to conceive. (1|⊕⊕⊕⊕)
Management of Dyslipidemia
Î 1.9a. ES recommends against the use of statins in women with
diabetes who are attempting to conceive. (1|⊕⊕
)
Î 1.9b. in view of their unproven safety during pregnancy, ES suggests
against the routine use of fibrates and/or niacin for women with
diabetes and hypertriglyceridemia attempting to conceive. (2|⊕⊕
)
Î 1.9c. ES suggests bile acid-binding resins may be used in women
with diabetes to treat hypercholesterolemia. However, this is seldom
warranted. (2|⊕⊕
)
Thyroid Function
Î 1.10. For women with type 1 diabetes seeking conception, ES
recommends measurement of serum TSH and, if their thyroid
peroxidase status is unknown, measurement of thyroid peroxidase
antibodies before withdrawing contraceptive measures or otherwise
trying to conceive. (1|⊕
)
Overweight and Obesity
Î 1.11. ES recommends weight reduction before pregnancy for
overweight and obese women with diabetes. (1|⊕⊕⊕
)
