Breastfeeding with Parkinson’s Disease

Despite the fact that Parkinson’s disease is more common in the elderly, 4-10% of patients experience the onset of the disease before the age of 40. In the USA, about four hundred women under the age of 50 are diagnosed with Parkinson’s disease each year, while such statistics for Russia could not be found.

Young women start families, become pregnant, and give birth. Breastfeeding is important for the mother and baby, both as the best nutrition for the child and as a contribution to their future health, as well as the closest bond—love between the little one and their mother. Is it possible to achieve such natural feeding when you have Parkinson’s disease?

One of the most commonly used drugs for treating Parkinson’s disease is Levodopa. It is a natural amino acid, a direct precursor of dopamine, and has similar effects. This drug is considered low risk during breastfeeding. Levodopa is excreted in breast milk in clinically insignificant amounts, 100 times lower than the dose used for infants who need it ( Thulin, 1998). In infants whose mothers took Levodopa, no short-term or long-term problems were observed ( Thulin, 1998). The risk of taking this medication is that it reduces prolactin secretion ( WHO 2002, Petraglia 1987, Nattero 1986, Linkowski 1983, Kaulhausen 1982, Rao 1982), prolactin is the hormone responsible for the volume of milk produced

Two cases are described: in one case, the mother breastfed for 4.5 months while taking the medication, and stimulation through sucking was sufficient to maintain a good milk supply despite the therapy. In the second case, the mother, suffering from Parkinson’s disease, was very difficult to treat and received continuous intravenous infusion of Levodopa and duodenal gel of Carbidopa during pregnancy and after childbirth. This mother breastfed for 3 months, the child’s psychomotor development was normal, unlike the child’s weight, which was affected by intrauterine malnutrition (Zlotnik 2014)

To avoid the side effects of levodopa (nausea, vomiting, arrhythmias), levodopa is combined with carbidopa or benserazide, which block peripheral enzymes that metabolize levodopa, allowing more levodopa to reach the brain, thus enabling a lower dose of levodopa to be prescribed. Carbidopa, which is combined with levodopa, inhibits levodopa’s suppressive effect on prolactin and increases its level, which is beneficial for breastfeeding ( Camanni 1978). To date, there are no published data on the excretion of this drug in breast milk. The wide volume of distribution and short half-life make it unlikely for carbidopa to enter breast milk in significant amounts.

If we take a broader look at the group of anticholinergic and dopaminergic agents used to treat Parkinson’s disease, it can be noted that the drugs are categorized by their impact on breastfeeding into groups of low, high, and very high risk.

In the low-risk group: levodopa, carbidopa, amantadine hydrochloride, apomorphine hydrochloride, biperiden, orphenadrine. These drugs have a very low likelihood of entering breast milk, and most of them reduce prolactin levels. Biperiden is the only drug that does not affect prolactin. Caution is advised with apomorphine and orphenadrine when prescribing to mothers of premature infants and infants in the first 7 days of life, when intestinal permeability is increased.

High-risk group: bromocriptine mesylate, pramipexole, procyclidine, ropinirole hydrochloride. This group has a stronger effect on prolactin and suppresses lactation. Bromocriptine does not enter breast milk at all and poses no danger to the infant when taken by the mother. It is better to postpone the use of ropinirole hydrochloride by the mother for the first 20 days of the child’s life.

Rasagiline also suppresses prolactin production. The effect of this drug on breastfeeding has not yet been studied, so it is currently in the very high-risk group.

If you have Parkinson’s disease and are a nursing mother, consult a neurologist specializing in Parkinson’s to select the optimal and safe therapy for you and your baby.

If you have been prescribed medications that affect prolactin levels, to ensure everything goes well, it is necessary to monitor several things:

• purchase or rent a baby scale and monitor your baby’s morning weight once a week. In the first 3 months of life, a baby gains at least 150g per week, optimally around 200g. If the weight gain is less, you will need to weigh more often and seek assistance in organizing breastfeeding and calculating supplementary feeding
• ask for help from a professional in latching the baby to the breast, the baby must be latched very well to ensure good breast emptying and sufficient milk quantity;
• use asymmetric latch, carefully monitor the swallowing, enhance the milk ejection reflex with breast compression according to Newman, massage, warm drinks;
• supplement feeding with pumping if there is not enough milk. Depending on the amount of milk and how much energy you have, this may be a couple of pumping sessions or more. In this case, it is better to get a recommendation from a breastfeeding consultant
• Skin-to-skin contact with your baby during the day will help you relax and make feedings easier.

Thus, breastfeeding, even with Parkinson’s disease, is a great benefit for your baby. You should not give it up—just choose the right medications and treatment plan. Specialists at our medical center will gladly assist and support mothers with this condition.

Olga Vladimirovna Nodvikova,

Breastfeeding Consultant, Neonatologist
V.S. Buzaev International Medical Centre®