Objective: To investigate the literature on pregnancy in the setting of Parkinson’s disease (PD) in order to better understand and treat women who become pregnant.

Background: PD only presents before the age of 40 in about 5% of cases and it is estimated that only about 400 women less than 50 years old are diagnosed with PD each year in the United States. Additionally, epidemiologic studies have shown that men are more than 1.5-2 times as likely to develop PD than women. As a result, the incidence of pregnancy in the setting of PD is relatively low and our knowledge is largely limited to cases reported in the literature. There has not been a systematic update to the literature in nearly 20 years. As a result, knowledge in treating and counseling women of childbearing age with PD is lacking.

Methods: We collected reports in the English literature from 1985 to 2016 to find cases of pregnancy and PD. Analysis of the papers included patient characteristics, birth outcomes, PD symptom control, use and dosages of anti-parkinsonian medications during pregnancy.

Results: There are 79 cases of pregnancy and PD reported in the literature from 28 separate articles. Of those, 75 resulted in live births. Regarding motor symptom outcomes, 41% of women were found to have worsening of their PD symptoms while 44% were found to have no change or improvement in PD symptoms. PD symptom control was not mentioned in 14% of cases. Regarding medication use in the setting of PD and pregnancy, levodopa was by far the most common medication used, with 47 pregnancies discussed. The dose of levodopa used ranged from 100 to 2500mg/day. No major abnormality (other than one case of osteomalacia) or birth complications were directly related to levodopa use. In cases where both medication status and symptoms were reported, 64% of women who were treated with anti-PD medications had improvement or stability during pregnancy, compared to only 33% of women who were not treated with anti-PD medication. Limited cases of dopamine agonists, anticholinergics, MAO-B and COMT inhibitors were also found. There is strong evidence of poor fetal outcomes associated with amantadine use.

Conclusions: Women with PD should be counselled that pregnancy has variable effects on PD symptoms and that levodopa has been used safely in many patients. Amantadine use should be avoided if possible and there is insufficient data to make recommendations on the use of other PD medications.

References: 1. Haaxma CA, Bloem BR, Borm GF, et al. Gender differences in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2007;78(8):819-824. doi:10.1136/jnnp.2006.103788.

2. Kranick SM, Mowry EM, Colcher A, Horn S, Golbe LI. Movement disorders and pregnancy: A review of the literature. Mov Disord. 2010;25(6):665-671. doi:10.1002/mds.23071.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pregnancy-and-parkinsons-disease-a-review-and-update/