Objective: Few reports describe experience with treatment of Parkinson’s disease [PD] during pregnancy. About 5% of the population with PD are young onset (onset prior to 40 yrs); of these < 50% are female.[1] The incidence of pregnancy in this population seems to be very low, and sharing the experience of treating a patient with PD through a pregnancy is important.

Background: There are few reports as to the safety and efficacy of the use of dopaminergic therapies for PD in pregnancy. The limited number of cases prevents valid study as to potential outcomes. Many of the case reports focus on the outcomes of the patient’s status, with escalation of PD during the pregnancy often noted.[2,3] Recognition of safe treatment options is needed for best control of patients through a pregnancy. Bromocriptine is an ergot-derived dopamine agonist [EDDA]. This class of medications has been recognized as leading to valvular heart disease [4]; bromocriptine, while considered safe for use during pregnancy, has been shown to impart the risk for a dose-related cardiac valve thickening.[5] Short-term use is less likely to cause structural valvular changes. Use of a related EDDA during pregnancy, cabergoline, has been reported as beneficial for symptom control without long-term complications. [6]

Method: A 40 year old patient with PD presented to our clinic reporting that she was pregnant. Treatment included pramipexole, 0.25 mg TID, and carbidopa/levodopa 25/100, 1 TID, at that date. At 8 weeks gestation, she stopped all of her PD medications due to concern about potential fetal risk. Her PD symptoms (tremor, rigidity, bradykinesia) escalated; at 11 weeks she restarted carbidopa/levodopa on the advice of her obstetrician. At 16 weeks, she developed wearing off and bromocriptine was started in an effort to ease the motor fluctuations.

Results: The patient underwent cesarean section at 40 weeks and was delivered of a robust male infant with Apgar scores of 9 and 10 at 1 and 5 minutes. Following her delivery, she weaned the bromocriptine.

Conclusion: Pregnancy in patients with PD is an infrequent occurrence, due to the rare incidence of PD in women of child bearing age. Recognition that this can occur and knowledge of the treatment options is needed. While bromocriptine is not ideal for long-term use in patients with PD due to idiosyncratic risk for valvular heart disease, short-term use during pregnancy may provide significant symptomatic benefit.

References: 1. Golbe, LI. Pregnancy and Movement Disorders. Neurol Clin 1994;12:497-508. 2. Hagell P, Odin P, Vinge E. Pregnancy in Parkinson’s Disease: A Review of the Literature and a Case Report. Mov Disord. 1998;13(1):34-38. 3. Shulman LM, Minagar A, Weiner WJ. Brief Report: The Effect of Pregnancy in Parkinson’s Disease. Mov Disord. 2000;15(1):132-135. 4. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli, G. Heart Disease and the Use of Dopamine Agonists for Parkinson’s Disease. Engl J Med 2007; 356:39-46. DOI: 10.1056/NEJMoa054830 5. Tan LC1, Ng KK, Au WL, Lee RK, Chan YH, Tan NC. Bromocriptine use and the risk of valvular heart disease. Mov Disord. 2009 Feb 15;24(3):344-9. doi: 10.1002/mds.22228. 6. Scott M, Chowdhury M. Pregnancy in Parkinson’s disease: Unique case report and review of the literature. Mov Disord. 2005;20(8);1078-1079. doi:org/10.1002/mds.20560

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