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A Report on Pregnancy and Parkinson’s Disease

About half of women with Parkinson’s disease (PD) who become pregnant experience worsening of their PD movement symptoms during pregnancy, according to a new review of the sparse medical literature on PD and pregnancy.  For some, taking levodopa medications can help; and based on limited data, these drugs seem to be safe for both mother and child.  In addition, Parkinson’s does not appear to increase the risk of birth complications or birth defects.  The study appears in the May 11 online edition of Parkinsonism and Related Disorders.
 
Parkinson’s usually develops after the age of 55 — well past childbearing years.  Yet, about 400 women under the age of 50 are diagnosed with PD in the United States each year. It is unknown how many become pregnant. 

To understand how pregnancy affects PD symptoms, and how PD and its treatments affect a pregnancy, Mara Seier, M.D., and Amie Hiller, M.D., at the Portland, OR, VA Medical Center, searched the English language medical literature for cases of pregnancy and PD.  In the 28 papers published between 1985 and 2016, they found reports of 74 live births to women with PD who were 23 to 46 years old.

Results

  • About half of women experienced worsening of Parkinson’s symptoms during pregnancy.
  • Parkinson’s medications reduced worsening of symptoms for only a third of women who took them.
  • Parkinson’s did not seem to increase the risk of complications in giving birth, or of birth defects in the baby.
  • Of all Parkinson’s medications, the most data on use and safety has been gathered on levodopa — enough to recommend prescribing it if needed, but not enough to prove it is safe.
  • Whether they have Parkinson's or not, women trying to conceive or who become pregnant should not take amantadine.
  • Not enough is known about COMT inhibitors (entacapone) or MAO-B inhibitors (selegiline, rasagiline) to comment on their safety.
  • Breastfeeding while taking PD medications is typically not advised, because so little is known about secretion of these drugs into breast milk.

What Does It Mean?

Pregnancy may be uncommon among women with PD, but neurologists should be prepared to treat women who are trying to conceive or who become pregnant.  The limited evidence available suggests that levodopa can safely be taken for PD movement symptoms during pregnancy.  Possible explanations for worsening of symptoms include PD progression, changes in how PD medications are metabolized during pregnancy, the physical stress of pregnancy, or simply taking too little levodopa. 

The study authors caution that their recommendations are based on a relatively small number of cases. There have been no formal clinical trials, which means pregnant women and their providers should rely on available data and use common sense. Medications with limited effects should be avoided, and motor symptoms controlled with physical therapy, occupational therapy and levodopa as needed. Collecting additional data is timely, and the researchers aim to develop a registry. They plan to collect data on women with PD who become pregnant, which would help in developing guidelines for giving them the best care.

Reference: Seier M, Hiller A (2017). Parkinson’s Disease and Pregnancy: An Updated Review. Parkinsonism and Related Disorders http://dx.doi.org/10.1016/j.parkreldis.2017.05.007

Friday, July 28, 2017
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