Objective: To describe the clinical course and treatment challenges of early-onset Parkinson’s disease (EOPD) during pregnancy and breastfeeding

Background: Parkinson’s disease (PD) is rare in women of reproductive age,and data on pregnancy and breastfeeding are scarce. Women with PD are underrepresented in research, leaving gaps in reproductive health and treatment strategies[1]. Management during pregnancy is challenging due to limited safety data for dopaminergic therapies,often requiring reliance on levodopa.Pregnancy outcomes are generally favorable,though clinical management remains complex[2].

Method: Clinical evaluation and follow-up of a woman with EOPD,including neurological and genetic assessment.

Results: We report a 40-year-old woman with EOPD.Onset at 31 with left-hand dystonia,6 months later progressing to ipsilateral foot dystonia.Pramipexole ER achieved response.

At 34,worsening dystonia required botulinum toxin; therapy switched to rotigotine and amantadine,with stability. At 37, levodopa/carbidopa (250/25 mg) was added with response.

Due to motor fluctuations, DBS was considered;however, pregnancy at 38 and surgery deferred. Rotigotine and amantadine were discontinued, and therapy continued with levodopa/carbidopa only,with worsening motor symptoms and right-hand tremor.First trimester: fatigue and 7-kg weight loss.

In the second trimester, after a fall from standing height, levodopa was adjusted to 312.5 mg/day.Pregnancy progressed without obstetric complications.Delivery via cesarean, with healthy newborn (Apgar 9/9; 2785 g).

During breastfeeding,sleep disruption,fatigue,anxiety,and worsening NMS with increased dystonic pain.A sixth levodopa dose increased LED from ~490 mg pre-pregnancy to 1125 mg/day during lactation, with response.

After breastfeeding cessation,rotigotine was reintroduced with improvement of motor symptoms and NMS.

Genetic testing with whole-exome sequencing, including CNV and mtDNA analysis, revealed no pathogenic variants associated with EOPD.

Conclusion: This case highlights the challenges of EOPD management during pregnancy and breastfeeding. Dopaminergic drug withdrawal required levodopa monotherapy, increasing LED from 490 mg pre-pregnancy to 1125 mg during lactation. Similar levodopa reliance during pregnancy has been reported [3].These findings underscore the need for evidence-based guidance for PD care during pregnancy and breastfeeding.

References: 1. Lehn, A. C., Lee, J. Y., Sciacca, G., Patterson, S., Morton, A., Pun, P., … & Berg, D. (2026). The Management of Parkinson’s disease before, during and after pregnancy—an MDS scientific issues committee review. Movement Disorders Clinical Practice, 13(1), 44-59.

2. Kapelle, W. M., Oosterbaan, A. M., Patane, G., Piat, C., Ghoniem, K. E., Camerucci, E., … & Savica, R. (2025). Pregnancy and delivery in women with Parkinson’s disease: A case series. Journal of Parkinson’s Disease, 15(4), 913-918.

3. Armas, C., Gushiken, G., Nunez, Y., & Cosentino, C. About pregnancy in Parkinson’s disease. Journal of Parkinson’s Disease, 1877718X251413026.

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