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International Parkinson and Movement Disorder Society

Pregnancy and Parkinson’s Disease: What Clinicians Need to Know

Date: August 2025
Prepared by SIC Members: Alexander C. Lehn, MD
Authors: Daniela Berg, MD, PhD; Bart Post, MD, PhD; and Adam Morton, MD
Editors: Lorraine Kalia, MD, PhD and Jeffery H. Kordower, PhD

 


For women with Parkinson’s disease (PD) who are considering children, pregnancy can raise difficult questions. For example, women may wonder: Should medications be changed? Can I breastfeed? How will PD symptoms change throughout pregnancy? What if I already have deep brain stimulation (DBS)? Currently, many of these questions lack clear, evidence-based answers, and there is little guidance available to help address them.  

To help address these gaps, the MDS Scientific Issues Committee assembled an interdisciplinary team—from neurology and obstetric medicine to psychiatry and lived experience—to produce a review article summarizing what we know, and offering pragmatic, experience-based guidance for clinicians and patients alike. Here we share highlights from the review article, drawn from answers provided by some of the authors. 

 

Article Overview

Jump to: 

  1. What are some of the most common clinical questions patients or colleagues pose regarding PD and pregnancy?
  2. Which PD medications are considered safest during pregnancy and breastfeeding for both motor and non-motor symptoms, and which should be avoided?
  3. Is DBS safe during pregnancy, and what special considerations apply for women with DBS who are planning pregnancy?
  4. Why is a multidisciplinary care team important for pregnant women with PD? Who should be involved, and when?
  5. Where is the biggest knowledge gap in managing PD during pregnancy—what research is needed to help fill it?

Reference

 

1. What are some of the most common clinical questions patients or colleagues pose regarding PD and pregnancy? 

Bart Post

In clinical practice, both patients and healthcare professionals often have many questions about pregnancy and PD. This is not surprising, given how rarely women of childbearing age present with PD in general neurology clinics, and the limited awareness and guidance currently available on this topic. At our center of excellence for PD, we have a special team addressing these questions.

The most important ones are: 

  1. Can I safely get pregnant when I have Parkinson’s disease?

  1. What are the chances of my child getting Parkinson’s disease?

  1. When I get pregnant what will this do to my symptoms of Parkinson’s disease? 

  1. When I am pregnant what do I do with my medication, especially with regard to possible teratogenic effects?

  1. When the child is born can I breastfeed my baby?

At the moment, the answers to all these questions are based on expert opinion and addressed in our newly published paper. We hope to get better evidence in the near future and add to the wellbeing of women with PD who want to get pregnant or are pregnant.

 

2. Which PD medications are considered safest during pregnancy and breastfeeding for both motor and non-motor symptoms, and which should be avoided? 

Adam Morton

Evidence regarding anti-parkinsonian medications during pregnancy and lactation is limited. Monotherapy is preferable.  For motor manifestations, the greatest safety data are for levodopa/carbidopa or levodopa/benserazide during pregnancy and lactation. While data are more limited, no significant increased risk has been observed with the use of dopamine agonists, MAO-B inhibitors, or anticholinergic drugs during pregnancy. Dopamine agonists may suppress lactation, and there are no safety data regarding the use of anticholinergic drugs, COMT and MAOB inhibitors during lactation. Amantadine is contraindicated in pregnancy because it poses a teratogenic risk and also suppresses lactation. During pregnancy and lactation, bisacodyl, lactulose, docusate, and macrogol may all be used safely for constipation. Domperidone and ondansetron may be used for nausea and vomiting. Proton pump inhibitors are safe for the management of gastro-oesophageal reflux. Tricyclic antidepressants, mirtazapine, and SSRIs (with the exception of paroxetine) may be used for anxiety, albeit with the risk of neonatal abstinence syndrome.  

 

3. Is DBS safe during pregnancy, and what special considerations apply for women with DBS who are planning pregnancy? 

Alex Lehn

Although DBS is well-established for treating motor symptoms in advanced PD, its use during pregnancy raises several practical and safety-related questions. Fortunately, the limited data we have—while far from definitive—are encouraging.

Only a small number of pregnancies in women with PD who had prior DBS have been documented. These women were all able to carry pregnancies to term without major complications. In two cases, women even discontinued PD medication entirely during pregnancy without clinical deterioration, suggesting that DBS may provide a helpful way to minimize fetal exposure to dopaminergic drugs.   

There are, however, important considerations:  

  1. Device management: Forward planning is important. Battery depletion during pregnancy should be avoided, so rechargeable systems are preferred, and elective generator replacement may be advisable before conception.

  1. Delivery considerations: During labour or caesarean section, stimulation should be switched off to avoid potential interference with fetal or maternal monitoring. Caution is also needed during surgical procedures to avoid damage to DBS hardware.

  1. Programming adjustments: Hormonal and physiological changes during pregnancy may affect DBS efficacy, and individual reprogramming may be required.

  1. Breastfeeding: There are no known contraindications to breastfeeding in women with DBS, and no evidence that stimulation adversely affects lactation.

While more data are needed—particularly regarding long-term child development outcomes and the hormonal interplay with neurostimulation—these early reports suggest that DBS is not only compatible with pregnancy but may, in some cases, simplify its management. 

 

4. Why is a multidisciplinary care team important for pregnant women with PD? Who should be involved, and when? 

Daniela Berg

PD is a complex disorder involving a wide range of motor and non-motor symptoms. All of these symptoms need to be managed from pre-conception through to the postpartum period. Even in women without PD, pregnancy is a time of major emotional, physical, and psychological change. In women with PD, these changes can amplify symptoms such as fatigue, anxiety, mood fluctuations, sleep disturbances, and mobility challenges. Importantly, PD medication needs to be carefully evaluated regarding safety for mother and child, and individually managed. 

Involvement of a multidisciplinary care team is therefore essential, including pre-conception genetic counselling, psychiatrists, pharmacists, and in case of DBS, possibly neurosurgeons. Involvement of these disciplines should be orchestrated by a movement disorders specialist, who then, during pregnancy, also involves further disciplines including obstetrics, sleep disorders specialists, physiotherapists, and social workers. Prior to delivery, involvement of obstetric anesthetists (including pain management), neonatologists, and specialist midwives are essential. 

The inclusion of individuals with lived experience of pregnancy and PD—either as peer mentors or as part of advisory teams—can offer invaluable insights and support for both patients and clinicians. 

 

5. Where is the biggest knowledge gap in managing PD during pregnancy—what research is needed to help fill it? 

Bart Post

The current lack of knowledge about the impact of pregnancy on PD is the effect on motor and non-motor symptoms and disease progression. Conversely, we also lack data on how PD impacts pregnancy—particularly regarding the safety of anti-parkinsonian medications and how the disease interacts with common pregnancy challenges such as nausea, constipation, and low blood pressure. The lack of evidence-based guidelines makes effective pregnancy care and decisions about future pregnancies difficult for both clinicians and women with PD.  Addressing these gaps requires global collaboration and systematic data collection. The recently established PregSpark registry provides an opportunity to generate robust, real-world evidence that will ultimately inform future guidelines and improve care for this unique patient population. 

 

Reference

  1. Lehn, A.C., Lee, J.-Y., Sciacca, G., Patterson, S., Morton, A., Pun, P., Kamel, W.A., Picillo, M., Post, B., Tan, E.-K., Capato, T., Bloem, B.R., Auffret, M., Oosterbaan, A.M., Kapelle, W., Bruno, M.K., Kalia, L.V., Kordower, J.H. and Berg, D. (2025), The Management of Parkinson's Disease Before, during and after Pregnancy—an MDS Scientific Issues Committee Review. Mov Disord Clin Pract. https://doi.org/10.1002/mdc3.70289