Objective: To evaluate the role of oral levodopa in patients with Parkinson’s disease (PD) during pregnancy, using the available literature, in order to determine the drug’s safety profile for both mother and fetus.

Background: PD is a neurodegenerative disease for which levodopa is the main drug used as treatment. The prevalence of PD increases with advancing age. However, approximately 5 to 10% of patients have an early-onset form; therefore, it can occur concomitantly with pregnancy. This incidence is unknown once data on the subject is limited to case reports.

Method: An active search was performed in the PubMed database, using the keywords “levodopa”, “pregnancy”, “Parkinson’s disease” and their equivalents. All articles published from 2003 to 2023 in any language were selected. The title and abstract were analyzed, duplicate results were eliminated and all studies that had the evaluation of the use of oral levodopa in patients with PD during pregnancy as their objective were included. Studies that analyzed only specific genetic mutations and animal studies were excluded.

Results: The search resulted in the selection of 41 articles, five of which met the inclusion criteria: one systematic review, two case series, one case report, and one multidisciplinary input. In pregnant women using levodopa, the fetus is exposed and metabolizes the drug, once it is transferred through the placenta. In general, levodopa was not associated with increases in the teratogenicity rate or birth complications. When birth defects were reported, these were minor anomalies, such as patent foramen ovale, permanence of the ductus arteriosus, clubfoot, and nose deformity. There are divergences between studies when it comes to numbers of spontaneous abortion. A 2020 study showed a 9.2% of miscarriage rate, while a 2017 study brings similar data on miscarriage compared to the control population. As for the evolution of motor symptoms, some studies indicate that it may worsen during pregnancy.

Conclusion: The literature on the use of levodopa during pregnancy on PD patients lacks data, no randomized clinical trial or large analytical observational study was found. However, among the information analyzed, there were benefits related to the permanency of the PD treatment during pregnancy, especially regarding the use of levodopa, which helps with the worsening of motor symptoms and is the most indicated medication.

References: Seier, M., & Hiller, A. (2017). Parkinson’s disease and pregnancy: An updated review. Parkinsonism & related disorders, 40, 11–17. https://doi.org/10.1016/j.parkreldis.2017.05.007
Tüfekçioğlu, Z., Hanağası, H., Yalçın Çakmaklı, G., Elibol, B., Esmeli Tokuçoğlu, F., Kaya, Z. E., Ertan, S., Özekmekçi, S., & Emre, M. (2018). Use of anti-Parkinson medication during pregnancy: a case series. Journal of neurology, 265(8), 1922–1929. https://doi.org/10.1007/s00415-018-8937-1
Ha, D. E., Legendre, G., & Colau, J. C. (2007). Maladie de Parkinson juvénile et prématurité récidivante. A propos d’un cas [Juvenile Parkinson’s disease and recurring prematurity. Case report]. Gynecologie, obstetrique & fertilite, 35(3), 224–227. https://doi.org/10.1016/j.gyobfe.2006.12.022
Young, C., Phillips, R., Ebenezer, L., Zutt, R., & Peall, K. J. (2020). Management of Parkinson’s Disease During Pregnancy: Literature Review and Multidisciplinary Input. Movement disorders clinical practice, 7(4), 419–430. https://doi.org/10.1002/mdc3.12925
Mehanna, R., & Jankovic, J. (2019). Young-onset Parkinson’s disease: Its unique features and their impact on quality of life. Parkinsonism & related disorders, 65, 39–48. https://doi.org/10.1016/j.parkreldis.2019.06.001

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MDS Abstracts - https://www.mdsabstracts.org/abstract/analysis-of-levodopa-use-in-patients-with-parkinsons-disease-during-pregnancy-a-systematic-review-of-the-last-twenty-years/