How do you approach the management of ADPKD in pregnancy, considering the need to stop tolvaptan therapy?

I generally consider transition to pregnancy with respect to both tolvaptan and ACEi along the same time frame... discuss when initiating counseling about becoming pregnant and discontinue use when patient is about to start actively trying to conceive.

Additional counseling may be warranted re: blood...

This explanation further informed me regarding ADPKD management in pregnancy, a clinical context I have not encountered yet.