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October 2, 2002

Complications, Family Planning

Question from Fairfax, Virginia, USA:

I have had diabetes for 15 years and several years ago I was put on an ACE inhibitor which has gotten rid of the protein in my urine, and my diabetes is under good control. Now that I am married I would like to start a family, but I have read that I cannot be on an ACE inhibitor if I'm pregnant. If I have to stop taking the ACE inhibitor, I am scared about what might happen to my kidneys during a pregnancy. Did the ACE inhibitor fix them? Are they still damaged? Once I stop taking the ACE inhibitor will they will leak a lot of protein or is this a very long gradual thing? Has there been any research on what happens in pregnancy when people stop taking ACE inhibitors and get pregnant? Help! I would really like a baby but don't want to damage my body.

Answer:

ACE inhibitors are not used in pregnancy because of potential effects on the fetus. They may cause birth defects and have detrimental effects on the developing kidney system of the fetus. Thus, you would need to stop taking this medication prior to becoming pregnant.

I have had patients in a similar situation. Sometimes the protein in the urine does not return right away, and it will be important to monitor this during the pregnancy. As long as the amount of protein in the urine is less than 300 mg and you have otherwise normal kidney function, you should do well. However, you will be at some increased risk of developing preeclampsia.

OWJ