Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input

Abstract

Background There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase. Objective To evaluate the evidence for the treatment of PD during pregnancy and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting. Methods This involved (1) a literature review of available evidence for the use of oral medical therapy for the management of PD during pregnancy and (2) an anonymized survey of patients and clinical teams relating to previous clinical experiences. Results A literature review identified 31 publications (148 pregnancies, 49 PD, 2 parkinsonism, 21 dopa‐responsive dystonia, 32 restless leg syndrome, 1 schizophrenia, and 43 unknown indication) detailing treatment with levodopa, and 12 publications with dopamine agonists. Adverse outcomes included seizures and congenital malformations. Survey participation included patients (n = 7), neurologists (n = 35), PD nurse specialists (n = 50), obstetricians (n = 15), and midwives (n = 20) and identified a further 34 cases of pregnancy in women with PD. Common themes for suggested management included optimization of motor symptoms, preference for levodopa monotherapy, and normal delivery unless indicated by obstetric causes. Conclusions This study demonstrates the paucity of evidence for decision‐making in the medical management of PD during pregnancy. Collaboration is needed to develop a prospective registry, with longitudinal maternal and child health outcome measures to facilitate consensus management guidelines.

Young Onset Parkinson’s Disease: A Modern and Tailored Approach

“…The incidence of pregnancy during PD is unknown, and available knowledge is based on case reports and case-series [44,45]. In about 50% of women with YOPD, symptoms seem to deteriorate during pregnancy.…”

“…anism underlying a worsening of symptoms during pregnancy is likely multifactorial, including hormonal changes, physiological changes resulting in altered pharmacokinetics, and physical and social stress. The effect of anti-parkinsonian medication during pregnancy has been best documented for levodopa/carbidopa, with no evidence of major fetal abnormalities and a small amount of pregnancy related complications effects [44]. Levodopa appears to be the safest option as first-line treatment in pregnant women with YOPD, although this continues to be an area of further study and the proposed prospective registry in the latest review on this topic seems to be a good start [44].…”

“…The effect of anti-parkinsonian medication during pregnancy has been best documented for levodopa/carbidopa, with no evidence of major fetal abnormalities and a small amount of pregnancy related complications effects [44]. Levodopa appears to be the safest option as first-line treatment in pregnant women with YOPD, although this continues to be an area of further study and the proposed prospective registry in the latest review on this topic seems to be a good start [44]. Data on the effects of other pharmacological agents during pregnancy is limited [45].…”

Anästhesieführung bei Patienten mit Dopa-responsiver Dystonie (Segawa-Syndrom)

“…Über die Weitergabe von L‑Dopa in Kombination mit Decarboxylasehemmern während der Schwangerschaft liegen unterschiedliche Berichte vor. Eine teratogene Wirkung beim Menschen ist bisher nicht sicher belegt [ 6 ]. In der publizierten Kasuistik von Sinha et al.…”

Comment on: Management of Parkinson's Disease During Pregnancy

“…I read with interest the detailed literature review on the management of Parkinson's disease during pregnancy by Young and colleagues. 1 As the authors pointed out, there is a paucity of robust evidence to guide medication management in Parkinson's disease during pregnancy. However, the authors appeared to have omitted amantadine in their review.…”