Objective: To report additional cases to the literature of Parkinson’s disease (PD) and pregnant.

Background: Pregnancy in PD is a relatively rare occurrence as PD presents before the age of 40 in approximately only 5% of cases. Data about the impact of pregnancy on PD patients is scarce.The evidence suggests that being on treatment during pregnancy is associated with a more favorable outcome both for the mother and the baby compared to not being treated; the question which anti-PD medication should be preferred during pregnancy remains open. Nevertheless, levodopa has the most use and acceptance during pregnancy.The data for other pharmacological and surgical treatments is less clear.

Method: We describe retrospectively the course and outcome of pregnancy in five women with young-onset PD from our movement disorders unit.

Results: The average age at onset of motor symptoms in our patients was 30.4 y-o [24 -36]. The average duration of illness to pregnancy was 4.6 years [2 – 8]. Mean age at pregnancy was 35 y-o [30 – 38]. Two patients were taking levodopa/carbidopa (750/75 mg/day and 1000/100 mg/day) and one of them also pramipexole 0.75 mg/day. Both patients continued taking only levodopa during pregnancy and during breast feeding. Another patient was taking rasagiline 1 mg/day but was stopped at the beginning of pregnancy.

The three patients who were not taking any anti-PD medication reported an increase in motor symptoms during pregnancy and after delivery. All patients had full-term gestation and the psychomotor development of the children was normal. All patients were able to breastfeed for a limited time including the two patients who continued taking levodopa.

Conclusion: Two of our patients with no anti-PD treatment noted worsening of their motor symptoms during the course of pregnancy, probably related to the discontinuation of antiparkinsonian medications. The physiological mechanisms by which pregnancy can result in symptomatic change is poorly understood.

To date, there is no evidence to suggest higher rates of fetal or maternal complications or birth-related complications in women with PD, as well as in those who maintain treatment with levodopa and/or pramipexole, such as our two patients who had a healthy pregnancy and birth.

References: [1] Kranick SM, Mowry EM, Colcher A, Horn S, Golbe LI. Movement disorders and pregnancy: A review of the literature. Mov Disord. 2010;25(6):665–71.
[2] Seier M, Hiller A. Parkinson’s disease and pregnancy: An updated review. Park Relat Disord. 2017;40:11–7.
[3] Tüfekçioğlu Z, Hanağası H, Yalçın Çakmaklı G, Elibol B, Esmeli Tokuçoğlu F, Kaya ZE, Ertan S, Özekmekçi S, Emre M. Use of anti-Parkinson medication during pregnancy:
a case series. J Neurol. 2018 Aug;265(8):1922-1929
[4] Young C, Phillips R, Ebenezer L, Zutt R, Peall KJ. Management of Parkinson’s Disease During Pregnancy: Literature Review and Multidisciplinary Input. Mov Disord Clin Pract. 2020 Apr 9;7(4):419-430.

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