The Management of Parkinson's Disease Before, during and after Pregnancy—an MDS Scientific Issues Committee Review

Background: Pregnancy after a Parkinson's diagnosis presents complex challenges. Due to the paucity of literature, there is no evidence-based guidelines and protocols for preconception care, management of pregnancy, childbirth and the postpartum period in women with early-onset Parkinson's disease (PD). Decision-making can be fraught with uncertainty for both patients and healthcare providers. Objectives: This review is aimed to provide pragmatic advice to help guide women with PD before, during and after pregnancy, and to address key gaps in the existing literature. Methods: An interdisciplinary working group of movement disorder specialists, obstetricians, perinatal neuropsychiatrists, physiotherapist, pharmacist and individuals with lived experiences collaborated to assess published evidence. In areas lacking robust data, recommendations were derived from case studies, registries, clinical and personal expertise. Results: Key recommendations include: Motor Symptom Management: Levodopa remains the safest treatment during the perinatal period. Monotherapy is preferred over polypharmacy. Non-Motor Symptom Management: Some non-motor symptoms are particularly common in this patient group and warrant individualized care. Preconception Considerations: Proactive planning about medical management should be done before conception. Genetic counseling and screening should be provided if desired. Peripartum and Postpartum Considerations: The decision regarding mode of delivery should be based upon women's birth plans and obstetric indications. Breastfeeding should be cautiously considered depending on the need for pharmacological treatment. Conclusions: This article provides a framework for managing PD before, during and after pregnancy. Collaborative efforts and ongoing registries like PregSpark* will be important to develop robust, evidence-based guidelines in this unique population.