We report the case of a 28-year-old woman with a 10-year history of young onset PD. Her past medical history was remarkable for migraines and asthma. Preconceptionally, she had some worsening motor symptoms following discontinuation of selegiline, baclofen and amantadine requiring adjustment in levodopa-benserazide dose to 500/100 mg. She also remained on domperidone. In the first trimester of her pregnancy, her motor status remained stable, but she had developed depression requiring initiation of citalopram 20 mg. Throughout the second and third trimester, she was stable without any troublesome off-episodes or dyskinesia, but with residual mild to moderate right-sided bradykinesia and rigidity on the above levodopa/benserazide dose. Mood remained stable throughout the gestational period.

She presented in labor at 40+ weeks at the local hospital and delivered a healthy girl via uncomplicated vaginal delivery. She opted not to breastfeed due to concerns about toxic drug effects on the infant. Due to postpartum worsening in peak-dose dyskinesia and rigidity, amantadine and baclofen were reintroduced. Child developmental milestones within the first year of life were unremarkable.

Levodopa remains the most potent treatment for PD. This case supports previous case reports and observations that this drug appears safe during pregnancy and would be considered the drug of choice during pregnancy in women with PD in the absence of randomized controlled trials. Optimization of management of motor and non-motor symptoms such as well as tapering and discontinuation of potentially teratogenic drugs should be considered preconception