diff --git a/clang-tools-extra/include-cleaner/lib/Record.cpp b/clang-tools-extra/include-cleaner/lib/Record.cpp
--- a/clang-tools-extra/include-cleaner/lib/Record.cpp
+++ b/clang-tools-extra/include-cleaner/lib/Record.cpp
@@ -53,7 +53,7 @@
                     SourceRange Range, const MacroArgs *Args) override {
     if (!Active)
       return;
-    recordMacroRef(MacroName, *MD.getMacroInfo());
+    recordMacroRef(MacroName, *MD.getMacroInfo(), RefType::Explicit);
   }
 
   void MacroDefined(const Token &MacroName, const MacroDirective *MD) override {
@@ -71,7 +71,7 @@
           llvm::is_contained(MI->params(), II))
         continue;
       if (const MacroInfo *MI = PP.getMacroInfo(II))
-        recordMacroRef(Tok, *MI);
+        recordMacroRef(Tok, *MI, RefType::Explicit);
     }
   }
 
@@ -80,17 +80,33 @@
     if (!Active)
       return;
     if (const auto *MI = MD.getMacroInfo())
-      recordMacroRef(MacroName, *MI);
+      recordMacroRef(MacroName, *MI, RefType::Explicit);
+  }
+
+  void Ifdef(SourceLocation Loc, const Token &MacroNameTok,
+                     const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
+  }
+
+  void Ifndef(SourceLocation Loc, const Token &MacroNameTok,
+                      const MacroDefinition &MD) override {
+    if (!Active)
+      return;
+    if (const auto *MI = MD.getMacroInfo())
+      recordMacroRef(MacroNameTok, *MI, RefType::Ambiguous);
   }
 
 private:
-  void recordMacroRef(const Token &Tok, const MacroInfo &MI) {
+  void recordMacroRef(const Token &Tok, const MacroInfo &MI, RefType RT) {
     if (MI.isBuiltinMacro())
       return; // __FILE__ is not a reference.
     Recorded.MacroReferences.push_back(
         SymbolReference{Tok.getLocation(),
                         Macro{Tok.getIdentifierInfo(), MI.getDefinitionLoc()},
-                        RefType::Explicit});
+                        RT});
   }
 
   bool Active = false;
diff --git a/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp b/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
--- a/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
+++ b/clang-tools-extra/include-cleaner/unittests/RecordTest.cpp
@@ -7,12 +7,13 @@
 //===----------------------------------------------------------------------===//
 
 #include "clang-include-cleaner/Record.h"
+#include "clang/Basic/SourceLocation.h"
 #include "clang/Frontend/FrontendAction.h"
 #include "clang/Frontend/FrontendActions.h"
 #include "clang/Testing/TestAST.h"
 #include "clang/Tooling/Inclusions/StandardLibrary.h"
-#include "llvm/Support/VirtualFileSystem.h"
 #include "llvm/ADT/ArrayRef.h"
+#include "llvm/Support/VirtualFileSystem.h"
 #include "llvm/Support/raw_ostream.h"
 #include "llvm/Testing/Support/Annotations.h"
 #include "gmock/gmock.h"
@@ -218,6 +219,45 @@
   EXPECT_THAT(ExpOffsets, ElementsAreArray(MainFile.points("exp")));
 }
 
+TEST_F(RecordPPTest, CapturesConditionalMacroRefs) {
+   llvm::Annotations Header(R"cpp(
+    #define Z 2
+  )cpp");
+
+  llvm::Annotations MainFile(R"cpp(
+    #include "header.h"
+
+    #define X 1
+
+    #ifdef ^X
+     #define Y 2
+    #endif
+
+    #ifndef ^Z
+     #define W 3
+    #endif
+  )cpp");
+
+  Inputs.Code = MainFile.code();
+  Inputs.ExtraFiles["header.h"] = Header.code();
+  auto AST = build();
+
+  std::vector<unsigned> RefOffsets;
+  std::vector<std::string> RefNames = {"X", "Z"};
+  SourceManager &SM = AST.sourceManager();
+  ASSERT_THAT(Recorded.MacroReferences, Not(IsEmpty()));
+
+  for (auto I = 0u; I < Recorded.MacroReferences.size(); I++) {
+    const auto &Ref = Recorded.MacroReferences[I];
+    auto [FID, Off] = SM.getDecomposedLoc(Ref.RefLocation);
+    ASSERT_EQ(FID, SM.getMainFileID());
+    EXPECT_EQ(Ref.RT, RefType::Ambiguous);
+    EXPECT_EQ(RefNames[I], Ref.Target.macro().Name->getName());  
+    RefOffsets.push_back(Off);
+  }
+  EXPECT_THAT(RefOffsets, ElementsAreArray(MainFile.points()));
+}
+
 // Matches an Include* on the specified line;
 MATCHER_P(line, N, "") { return arg->Line == (unsigned)N; }