Objective: To examine the management of Parkinson’s Disease (PD) during pregnancy through i) literature review and ii) patient and multi-disciplinary team (MDT) survey.

Background: The incidence of pregnancy in women with PD is unclear, although this may rise given the trend towards increasing maternal age.[1] Previous case series document outcomes in multiple pregnancies, including adverse events such as spontaneous abortion.[2,3] Information about the use of PD medication during pregnancy is largely anecdotal and lacks long-term follow-up. Lack of evidence-based practice and standardised clinical guidelines means clinicians and patients face uncertainty as to how best care may be achieved.

Method: Results of our literature review were evaluated in accordance with the GRADE quality criteria, and information collected via online survey from: women with PD who had been pregnant since diagnosis, neurologists, obstetricians, midwives and PD specialist nurses. Five key domains were examined: use of PD medication and symptoms during pregnancy, organisation and provision of clinical care, adverse obstetric events and delivery, and the post-partum period, breastfeeding and support. Healthcare professionals without experience in this setting were invited to share suggested management plans.

Results: Literature review identified the predominance of evidence for the use of levodopa and dopamine agonists during pregnancy, totalling 309 pregnancies and 14 adverse events (e.g. placental abruption. [2-39] A total of 127 completed online surveys were received; patients (n=7, 10 pregnancies), neurologists (n=35), PD Nurse Specialists (n=50), obstetricians (n=15), midwives (n=20). Overall, this study identified 20 further pregnancies in women with PD, with medication continued in nine, and only a single reported complication (stillbirth at 24 weeks) in the context of levodopa treatment. Consensus MDT opinion was of early, active communication between Neurology and Obstetric teams, and increased frequency of clinical review during gestation.

Conclusion: This study is the first to report clinical outcomes of PD during pregnancy from both patients’ and clinicians’ perspectives and to gather wider multi-disciplinary opinion on the optimum approach to care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-management-of-parkinsons-disease-during-pregnancy-literature-review-case-series-and-multi-disciplinary-input/