There is only a small percentage of pregnancies in women with Parkinson’s
(most likely due to the fact that most people develop the disease later in
life), so evidence is very limited and consequently many questions remain
unanswered. It should be stressed, however, that most pregnancies in women with
Parkinson’s have successful outcomes.
The use and effect of medications
Unfortunately there is insufficient experience to draw any reliable conclusions
regarding the safety of Parkinson’s medications during pregnancy. As always you
should discuss medication with your doctor, preferably before you become
pregnant or as soon as you know you are, and also if you plan to breast-feed,
so that any necessary changes to medication can be made.
- Levodopa-based medication -
although there is limited experience of its use during pregnancy, levodopa
is presently the preferable medication recommended to control severe
symptoms whilst pregnant
- Dopamine agonists - can
also be prescribed, although experience of these in pregnancy is limited
- Selegiline,
rasagiline
- safety is unclear as there is insufficient evidence at present
- Entacapone,
tolcapone
- safety is unclear as there is insufficient evidence at present
- Amantadine
(and other newer medications) – should be avoided during pregnancy:
experience from studying animals indicates that amantadine could be
toxic/teratogenic (i.e. able to disturb the growth and development of an
embryo or foetus).
If for any reason your dosage of medications is reduced, you will probably
find that your Parkinson’s symptoms are less well controlled and this, combined
with hormonal changes and pregnancy-associated stress, may exacerbate symptoms.
In this situation controlling stress is preferable to taking further medications.
For further information on stress and how to overcome it see (Coping with stress).
Foetal development
As stated above, amantadine might have a negative impact on the development
of the foetus and should be avoided during pregnancy. As for other medications,
experience at present is too limited to draw any accurate conclusions.
Motor symptoms
In some people motor symptoms, notably tremor, appear to worsen during
pregnancy but this is not always the case and for others there is no sudden
progression or increase in symptoms at all. Again, there is no general rule
because everyone is different.
Breast-feeding
Unfortunately there is currently insufficient evidence to establish whether
it is safe or not to breast-feed when taking Parkinson’s medications.
- Levodopa and MAO-B inhibitors
(selegiline, rasagiline) – it is unclear whether they pass over to the
breast milk and, if so, what effects it could have on the child
- Dopamine agonists (e.g. ropinirole,
pramipexole,
rotigotine)
- can inhibit the production of breast milk, but it is not known if they
pass over to the milk itself and, if so, what effects it could have on the
child
- Amantadine and the COMT
inhibitors (entacapone, tolcapone) - do pass over to breast milk but the
effects that they might have on the child are as yet unclear – they should
therefore be avoided during breast feeding
- Domperidone (used to combat
nausea caused by other medications) - increases the production of breast
milk but is secreted in it so caution is required.
If you take Parkinson’s medication and plan to breast-feed seek advice from
your doctor.
