Safety of drugs used for complications of diabetes during pregnancy

Before conception or as soon as pregnancy is recognised, review all drugs used for complications of diabetes. This includes drugs to decrease risk of cardiovascular disease (eg blood pressure–lowering and lipid-modifying drugs) and drugs for microvascular complications (eg painful neuropathy).

Stop statins and other lipid-modifying drugs before conception, or as soon as possible in pregnancy. Women who develop significant hypertriglyceridaemia (eg triglyceride concentrations higher than 6 mmol/L) may require high-dose fish oil, most often in the third trimester—seek expert advice.

Angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are commonly used to reduce blood pressure or for nephroprotection in women with diabetes. Although the risk of teratogenic effects from ACEI and ARB is low, the risk of severe fetal kidney problems and other problems during the second and third trimesters is high. In most cases, these drugs should be stopped before the woman starts trying to conceive; for women with kidney disease, treatment is often continued pre-conception and stopped as soon as pregnancy is confirmed.

Alternative blood pressure–lowering drugs used in pregnancy include labetalol, nifedipine, methyldopa and clonidine. Seek specialist advice from a renal physician, obstetric medicine physician or obstetrician.