Highlights
- •About half of women experience worsening of PD symptoms during pregnancy.
- •Use of anti-PD medications reduces worsening of symptoms to only a third of patients.
- •Women with PD do not have higher rates of birth or fetal complications.
- •Levodopa has the most use and safety data to recommend its use during pregnancy.
- •Amantadine should be avoided in women trying to conceive or those who become pregnant.
Abstract
Pregnancy does not often occur in the setting of Parkinson's disease (PD) as the most
common age of onset is beyond the childbearing years, yet management of these two
conditions is crucial for the health of both mother and child. Here we review treatment
data of PD during pregnancy, primarily from case reports and drug registries, and
focus on available evidence regarding the pregnancy risks for patient and fetus. Historically,
it was reported that many women had worsening of symptoms during pregnancy but this
may be because anti-parkinsonian medications were not recommended or were under dosed.
Levodopa has the best safety data for use in pregnancy and amantadine should be avoided
in women who are pregnant or trying to become pregnant. The data for other pharmacological
and surgical treatments is less clear. There is no evidence that women with PD have
higher rates of birth or fetal complications.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Parkinsonism & Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mean age of mothers is on the rise: United States, 2000–2014 key findings data from the national vital statistics system.Natl. Cent. Heal. Stat. Data Br. 2016; 232: 1-7
- Gender differences in Parkinson's disease.J. Neurol. Neurosurg. Psychiatry. 2007; 78: 819-824https://doi.org/10.1136/jnnp.2006.103788
- Movement disorders and pregnancy: a review of the literature.Mov. Disord. 2010; 25: 665-671https://doi.org/10.1002/mds.23071
- Two cases of pregnancy in Parkinson's disease.Park. Relat. Disord. 2014; 20: 239-240https://doi.org/10.1016/j.parkreldis.2013.10.013
- Pregnancy in Parkinson's disease: a review of the literature and a case report.Mov. Disord. 1998; 13: 34-38
- Pregnancy in Parkinson's disease: unique case report and review of the literature.Mov. Disord. 2005; 20: 1078-1079https://doi.org/10.1002/mds.20560
- Antiparkinsonian treatment in pregnancy [1].Mov. Disord. 2002; 17: 428-429https://doi.org/10.1002/mds.10040
- Selegiline, pregnancy, and Parkinson's disease.Mov. Disord. 1998; 13: 175-176https://doi.org/10.1212/NXI.0000000000000039
- Parkinson's disease and pregnancy.Neurology. 1987; 37: 1245-1249
- The effect of pregnancy in parkinson’s disease.Mov. Disord. 2000; 15: 132-135
- Successful pregnancy and delivery in a patient with Parkinson's disease under pramipexole treatment.Press. Medicale. 2014; 43: 83-85https://doi.org/10.1016/j.lpm.2013.01.067
- Levodopa-carbidopa intestinal gel (LCIG) infusion during pregnancy and delivery: first documented case.Park. Relat. Disord. 2014; 20: 1317-1318https://doi.org/10.1016/j.parkreldis.2014.09.018
- Pramipexole-treated Parkinson's disease during pregnancy.Mov. Disord. 2004; 19: 1114-1115https://doi.org/10.1002/mds.20148
- Pregnancy in Parkinson's disease: case report and discussion.Expert Rev. Neurother. 2008; 8: 1799-1805https://doi.org/10.1586/14737175.8.12.1799
- Short episode of seizures in a newborn of a mother treated with levodopa/carbidopa/entacapone and bromocriptine.Mov. Disord. 2007; 22: 1515https://doi.org/10.1002/mds.21494
- Pregnancy in Parkinson's disease: a review of the literature and a case report.Mov. Disord. 1999; 14: 194-195
- Levodopa in pregnancy.Mov. Disord. 1995; 10: 115
- Levodopa during pregnancy.Clin. Neuropharmacol. 1985; 8: 93-95https://doi.org/10.1097/00002826-198503000-00010
- Pregnancy and parkinsonism: a case report without problem.Clin. Neuropharmacol. 1989; 12: 217-219
- Juvenile onset Parkinson's disease.Adv. Neurol. 1986; 45: 213-216
- Multiparity after an initial diagnosis of Parkinson's disease: a report on a rare case.Fertil. Steril. 2008; 90: 2005-2006https://doi.org/10.1016/j.fertnstert.2008.01.037
- Successful twin pregnancy in a patient with parkin-associated autosomal recessive juvenile parkinsonism.BMC Neurol. 2011; 11: 72https://doi.org/10.1186/1471-2377-11-72
- Successful birth of an IVF baby in a patient with Parkinson's disease.J. Hum. Reprod. Sci. 2010; 3: 42-43
- Juvenile Parkinson's disease and recurring prematurity: case report.Gynecol. Obs. Fertil. 2007; 35: 224-227
- Levodopa in pregnancy.Mov. Disord. 1996; 11: 115-116
- Parkinson's disease and pregnancy: case report and literature review.J. Gynecol. Obstet. Biol. Reprod. Paris. 2000; 29 (Accessed 8 December 2016): 454-457
- Parkinson disease and pregnancy. Apropos of a case.J. Gynecol. Obstet. Biol. Reprod. Paris. 1990; 19 (Accessed 10 December 2016): 461-463
- Pregnancy and parkinson disease.Ugeskr. Laeg. 1991; 153: 1210-1211
- Deep brain stimulation during pregnancy and delivery: experience from a series of “DBS babies”.Front. Neurol. 2015; 6: 1-6https://doi.org/10.3389/fneur.2015.00191
- Levodopa in human breast milk Clinical implications.Neurology. 1998; 50: 1920-1921
- Parkinson's disease in women.Disease-a-Month. 2007; 53: 206-213https://doi.org/10.1016/j.disamonth.2007.02.002
- Movement disorders and pregnancy.in: J.F.R.W Autumn Klein J.H.W. Angela O'Neal M. Scifres Christina Neurol. Illn. Pregnancy Princ. Pract. first ed. 2016: 179-190
- Lifetime exposure to estrogens and Parkinson's disease in California teachers.Park. Relat. Disord. 2014; 20: 1149-1156https://doi.org/10.1016/j.parkreldis.2014.08.003
- Inhibition of striatal dopamine transporter activity by 17β-estradiol.Eur. J. Pharmacol. 1998; 345: 207-211https://doi.org/10.1016/S0014-2999(98)00008-9
- Hysterectomy, menopause, and estrogen use preceding Parkinson's disease: an exploratory case-control study.Mov. Disord. 2001; 16 (Accessed 2 January 2017): 830-837
- Gender differences in Parkinson's disease.Clin. Neuropharmacol. 1998; 21 (Accessed 10 January 2017): 118-121
- The relevance of gender in Parkinson's disease: a review.J. Neurol. 2017; : 1-25https://doi.org/10.1007/s00415-016-8384-9
- Reproductive life characteristics in females affected with parkinson's disease and in healthy control subjects – a comparative study on Polish population.Neurol. Neurochir. Pol. 2014; 48: 322-327https://doi.org/10.1016/j.pjnns.2014.08.004
- Risk of Parkinson disease in women: effect of reproductive characteristics.Neurology. 2004; 62: 2010-2014https://doi.org/10.1212/WNL.62.11.2010
- A case control study of women with Parkinson's disease and their fertility characteristics.J. Neurol. Sci. 2012; 319: 135-138https://doi.org/10.1016/j.jns.2012.05.026
- The effect of estrogen replacement on early Parkinson's disease.Neurology. 1999; 52: 1417
- Estrogen improves motor disability in parkinsonian postmenopausal women with motor fluctuations.Neurology. 2000; 54: 2292-2298
- Female reproductive factors, menopausal hormone use, and parkinson’s disease.. 2014; 29: 889-896https://doi.org/10.1002/mds.25771
- Is there a connection between estrogen and Parkinson's disease?.Park. Relat. Disord. 2002; 8: 289-295
- Hormone replacement therapy and Parkinson’ s disease risk in women: a meta-analysis of 14 observational studies.Neuropsychiatr. Dis. Treatment. 2015; 11: 59-66
- Effect of reproductive factors and postmenopausal hormone use on the risk of Parkinson.Neurology. 2005; 65: 383-390
- Births: final data for 2014.Natl. Vital Stat. Rep. Natl. Cent. Heal. Stat. 2015; 64
- National vital statistics reports estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008.Natl. Vital Stat. Rep. 2012; 60: 1-21
- Postencephalitic parkinsonism complicated by pregnancy.Am. J. Obs. Gynecol. 1939; 38: 334-337
- Human transplacental transfer of carbidopa/levodopa.J. Neural Transm. 1995; 9: 239-242
- Pregnancy outcome following use of levodopa, pramipexole, ropinirole, and rotigotine for restless legs syndrome during pregnancy: a case series.Eur. J. Neurol. 2013; 20: 1241-1246https://doi.org/10.1111/ene.12001
- Good obstetric outcome in a patient with Segawa disease.Arq. Neuropsiquiatr. 2012; 70: 559-560https://doi.org/10.1590/S0004-282X2012000700022
- Successful management of pregnancy in a patient with Segawa disease: case report and literature review.J. Obs. Gynaecol. Res. 2009; 35: 562-564https://doi.org/10.1111/j.1447-0756.2008.00956.x
- Levodopa in pregnancy.Mov. Disord. 1997; 12: 261
- Dopa-responsive dystonia: long-term treatment response and prognosis.Neurology. 1991; 41: 174-181https://doi.org/10.1212/WNL.41.2_Part_1.174
- Managing prolactinomas during pregnancy.Front. Endocrinol. (Lausanne). 2015; 6: 1-5https://doi.org/10.3389/fendo.2015.00085
- Exposure to high dosage trihexyphenidyl during pregnancy for treatment of generalized dystonia: case report and literature review.Neurology. 2011; 17: 340-341
- Uneventful use of haloperidol and trihehexyphenidyl during three consecutive pregnancies.Arch. Women Ment. Heal. 2011; 14: 83-84
- Birth defects and drugs in pregnancy.Am. J. Med. Genet. 1977; 1: 120-121
- Bromocriptine as prophylactic therapy in prolactinoma during pregnancy.Fertil. Steril. 1981; 36: 524-526https://doi.org/10.1016/S0015-0282(16)45806-1
Article info
Publication history
Published online: May 11, 2017
Accepted:
May 10,
2017
Received in revised form:
May 10,
2017
Received:
March 3,
2017
Identification
Copyright
Published by Elsevier Ltd.
