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Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input

BACKGROUND: There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase. OBJECTIVE: To evaluate the evidence for the treatmen...

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Autores principales: Young, Caitlin, Phillips, Rhiannon, Ebenezer, Louise, Zutt, Rodi, Peall, Kathryn J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197310/
https://www.ncbi.nlm.nih.gov/pubmed/32373659
http://dx.doi.org/10.1002/mdc3.12925
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author Young, Caitlin
Phillips, Rhiannon
Ebenezer, Louise
Zutt, Rodi
Peall, Kathryn J.
author_facet Young, Caitlin
Phillips, Rhiannon
Ebenezer, Louise
Zutt, Rodi
Peall, Kathryn J.
author_sort Young, Caitlin
collection PubMed
description BACKGROUND: There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase. OBJECTIVE: To evaluate the evidence for the treatment of PD during pregnancy and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting. METHODS: This involved (1) a literature review of available evidence for the use of oral medical therapy for the management of PD during pregnancy and (2) an anonymized survey of patients and clinical teams relating to previous clinical experiences. RESULTS: A literature review identified 31 publications (148 pregnancies, 49 PD, 2 parkinsonism, 21 dopa‐responsive dystonia, 32 restless leg syndrome, 1 schizophrenia, and 43 unknown indication) detailing treatment with levodopa, and 12 publications with dopamine agonists. Adverse outcomes included seizures and congenital malformations. Survey participation included patients (n = 7), neurologists (n = 35), PD nurse specialists (n = 50), obstetricians (n = 15), and midwives (n = 20) and identified a further 34 cases of pregnancy in women with PD. Common themes for suggested management included optimization of motor symptoms, preference for levodopa monotherapy, and normal delivery unless indicated by obstetric causes. CONCLUSIONS: This study demonstrates the paucity of evidence for decision‐making in the medical management of PD during pregnancy. Collaboration is needed to develop a prospective registry, with longitudinal maternal and child health outcome measures to facilitate consensus management guidelines.
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spelling pubmed-71973102020-09-29 Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input Young, Caitlin Phillips, Rhiannon Ebenezer, Louise Zutt, Rodi Peall, Kathryn J. Mov Disord Clin Pract Research Articles BACKGROUND: There are no standardized clinical guidelines for the management of Parkinson's disease (PD) during pregnancy. Increasing maternal age would suggest that the incidence of pregnancy in women diagnosed with PD is likely to increase. OBJECTIVE: To evaluate the evidence for the treatment of PD during pregnancy and to canvass opinion from patients and clinical teams as to the optimum clinical management in this setting. METHODS: This involved (1) a literature review of available evidence for the use of oral medical therapy for the management of PD during pregnancy and (2) an anonymized survey of patients and clinical teams relating to previous clinical experiences. RESULTS: A literature review identified 31 publications (148 pregnancies, 49 PD, 2 parkinsonism, 21 dopa‐responsive dystonia, 32 restless leg syndrome, 1 schizophrenia, and 43 unknown indication) detailing treatment with levodopa, and 12 publications with dopamine agonists. Adverse outcomes included seizures and congenital malformations. Survey participation included patients (n = 7), neurologists (n = 35), PD nurse specialists (n = 50), obstetricians (n = 15), and midwives (n = 20) and identified a further 34 cases of pregnancy in women with PD. Common themes for suggested management included optimization of motor symptoms, preference for levodopa monotherapy, and normal delivery unless indicated by obstetric causes. CONCLUSIONS: This study demonstrates the paucity of evidence for decision‐making in the medical management of PD during pregnancy. Collaboration is needed to develop a prospective registry, with longitudinal maternal and child health outcome measures to facilitate consensus management guidelines. John Wiley & Sons, Inc. 2020-04-09 /pmc/articles/PMC7197310/ /pubmed/32373659 http://dx.doi.org/10.1002/mdc3.12925 Text en © 2020 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Articles
Young, Caitlin
Phillips, Rhiannon
Ebenezer, Louise
Zutt, Rodi
Peall, Kathryn J.
Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title_full Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title_fullStr Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title_full_unstemmed Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title_short Management of Parkinson's Disease During Pregnancy: Literature Review and Multidisciplinary Input
title_sort management of parkinson's disease during pregnancy: literature review and multidisciplinary input
topic Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197310/
https://www.ncbi.nlm.nih.gov/pubmed/32373659
http://dx.doi.org/10.1002/mdc3.12925
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