Olivola Sara, Xodo Serena, Olivola Enrica, Cecchini Fabiana, Londero Ambrogio Pietro, Driul Lorenza
Department of Gynaecology and Obstetrics, School of Medicine of Udine, Udine, Italy.
IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, Pozzilli, Italy.
Front Neurol. 2020 Feb 19;10:1349. doi: 10.3389/fneur.2019.01349. eCollection 2019.
Pregnancy in Parkinson's disease is a rare occurrence, and to date, clinical experience with its management is rather limited. In clinical practice, doubts concern mainly the impact of PD on gestation, labor, and delivery as well as the safety of dopaminergic drugs. We report the case of a 40-year-old woman with an 8-year history of PD. In the first trimester of her pregnancy, her motor status was similar to the pre-conceptional period. In gestation week 16, her motor status dramatically worsened and she complained of predictable "off" periods in the afternoon. For this reason, her dose of L-DOPA/carbidopa was increased up to 500/125 mg per day. At 39 gestational weeks, she gave birth to a healthy girl with an Apgar score of 9 by an uncomplicated cesarean delivery. The child was not breast fed to avoid exposure to antiparkinsonian drugs. The L-DOPA/carbidopa dosage remained constant during the postpartum period. We performed a systematic review of the literature using Ovid Medline, Scopus, and PubMed (including Cochrane database). We used the search terms "Parkinson disease" AND "pregnancy." We identified 20 studies of PD in pregnancy with a total of 37 pregnant women with PD. The most important available data concern the safety of L-DOPA therapy during pregnancy. There seems to be some risk of worsening of the condition or upcoming of new PD symptoms during or shortly after pregnancy. More data concerning the safety of antiparkinsonian drugs in PD treatment, as well as the effect of pregnancy on parkinsonian symptoms are needed. According to the current state of the art, L-DOPA therapy should be considered preferable to other drugs during pregnancy.
帕金森病患者怀孕是罕见情况，迄今为止，其治疗的临床经验相当有限。在临床实践中，主要疑虑在于帕金森病对妊娠、分娩及产程的影响以及多巴胺能药物的安全性。我们报告一例有8年帕金森病病史的40岁女性病例。在她怀孕的头三个月，其运动状态与孕前相似。在妊娠第16周时，她的运动状态急剧恶化，且抱怨下午会出现可预测的“关”期。因此，她的左旋多巴/卡比多巴剂量增加至每日500/125毫克。在妊娠39周时，她通过无并发症的剖宫产分娩出一名健康女婴，阿氏评分9分。为避免接触抗帕金森病药物，该婴儿未进行母乳喂养。产后左旋多巴/卡比多巴剂量保持不变。我们使用Ovid Medline、Scopus和PubMed（包括Cochrane数据库）对文献进行了系统综述。我们使用了“帕金森病”和“妊娠”的检索词。我们确定了20项关于帕金森病患者妊娠的研究，共有37名帕金森病孕妇。现有最重要的数据涉及孕期左旋多巴治疗的安全性。在孕期或产后不久似乎存在病情恶化或出现新帕金森病症状的一些风险。需要更多关于抗帕金森病药物在帕金森病治疗中的安全性以及妊娠对帕金森病症状影响的数据。根据目前的技术水平，孕期左旋多巴治疗应被视为比其他药物更可取。
