Management of Parkinson’s Disease during pregnancy: Literature review and multi-disciplinary input

Abstract

Background There are no standardised clinical guidelines for the management of Parkinson’s disease during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with Parkinson’s disease is likely to increase.

Objective To evaluate the evidence for the treatment of Parkinson’s disease during pregnancy, and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting.

Methods This involved: i) a literature review of available evidence for the use of oral medical therapy for the management of PD during pregnancy, and ii) anonymised survey of patients and clinical teams relating to previous clinical experiences.

Results Literature review identified 31 publications (148 pregnancies; 49 Parkinson’s Disease, 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: optimisation 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.