Advise in each case:

Renal dysfunction in a pregnant woman diagnosed with DM type 1 (T1DM) is associated with an increased risk of adverse maternal and fetal outcomes, including an increased risk of preeclampsia. Mild preconceptional renal dysfunction manifeting only as microalbuminuria, may worsen during pregnancy with greater amounts of proteinuria. However, the degree of worsening is typically both modest and reversible once pregnancy is completed, so long as BP and blood glucose (Glu) remain well controlled during the pregnancy. Yet, more severe preconceptional renal dysfunction in preconception period can significantly deteriorate during pregnancy and may not be reversible. Therefore provide the appropriate advice in each case: 

R 1.6b Perform regular monitoring of renal function during pregnancy. (ungraded)

R 1.6a If GFR significantly reduced, refer to nephrologist and advise about possible worsening, if e-GFR is significantly reduced before pregnancy. (ungraded)

R 1.7c 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 and angiotensin receptor blockers. The patients should be informed about possible loss of renal protection if medication is discontinued and the risk of teratogenesis if continued. (ungraded)