Levodopa in Pregnancy
To the Editor:
We report a 27-year-old who had previously undergone chemotherapy and radiotherapy for non-Hodgkin's lymphoma in 1988 (1). She subsequently developed a progressive levodopa-responsive Parkinsonian syndrome and began treatment with co-careldopa (Sinemet Plus) in April 1992. She became pregnant in August 1992 and continued treatment with co-careldopa 375-mg daily, subsequently delivering a healthy boy, weighing 3540 g at 39 weeks gestation, by epidural and forceps delivery because of delay in the second stage of labour. Apgar scores were 9 at both 1 and 10 min. The mother produced significant quantities of milk but the baby was bottle fed because of the known excretion of levodopa in breast milk. Throughout the pregnancy the patient's Parkinsonian symptoms remained stable.
In animal studies there have been reports of teratogenicity of levodopa in rats at doses of 200 mg/kg. The abnormalities observed consisted of bone dysplasias and visceral abnormalities.
There have been two previous reports of successful outcome of pregnancy in patients taking levodopa and carbidopa, one of a singleton pregnancy and the other of twins (2). While the numbers of women of child-bearing potential requiring levodopa is small, there has as yet been no report of teratogenicity in humans. In view of the limited experience, however, it would seem important to collect all data on outcome of pregnancy in patients taking levodopa. Until a substantial body of data is available, there seems to be no reason to withhold levodopa during pregnancy, particularly in view of the possible harmful effects of poorly coordinated muscular contraction during the later stages of pregnancy and labour.