title: Pregnancy in women with gliomas: a case-series and review of the literature.
abstract: The occurrence of pregnancy in women with brain tumors confronts both patients and physicians with difficult decision making at each stage of pregnancy. We studied the course of events of nine pregnancies in seven women with low-grade glioma in our hospital over a 10 year period. Five patients had a surgical resection, one a biopsy and one woman was followed by wait-and-see policy before pregnancy. In two women, a therapeutic abortion was carried out in the first trimester because of signs of progression, necessitating surgical removal of the tumor. In the other five women pregnancy had an uncomplicated course. Based on a literature review, we found 28 women diagnosed with a known glioma before becoming pregnant. All pregnancies but one, were uneventful and all women had a normal delivery, including the seven cases with exposure to chemotherapy and in whom healthy babies were born. A total of 75 pregnant women were identified in whom new onset glioma developed, which was high-grade in 56 %, and becoming symptomatic in 51 % during the third trimester, usually by focal neurological deficits. We conclude that in relation to pregnancy, low-grade gliomas are more often seen in women already known with a brain tumor, while high-grade gliomas represent more frequently a new onset phenomenon. Based on these observations, guidelines are given on initiation of antitumor therapy during pregnancy, seizure management, counseling on therapeutic abortion, and on the timing and choice of obstetrical interventions.
authors: Department of Neurology, Medical Center Haaglanden, Lijnbaan 32, 2512 VK, The Hague, The Netherlands, h.zwinkels@mchaaglanden.nl.
authors: Hanneke
authors: H
authors: Zwinkels
authors: Joep
authors: J
authors: Dörr
authors: Fred
authors: F
authors: Kloet
authors: Martin J B
authors: MJ
authors: Taphoorn
authors: Charles J
authors: CJ
authors: Vecht
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000628:therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
references: J Neurol Neurosurg Psychiatry. 1986 Aug;49(8):874-80
references: 3746323
references: Epilepsia. 2013 Mar;54(3):405-14
references: 23360413
references: J Neurosurg. 2009 Dec;111(6):1150-7
references: 19408979
references: J Neurosci Nurs. 2010 Feb;42(1):28-37; quiz 38-9
references: 20187347
references: J Neurooncol. 1993 Mar;15(3):251-6
references: 8360710
references: Clin Oncol (R Coll Radiol). 2004 May;16(3):210-4
references: 15191010
references: Int J Cancer. 1997 Apr 10;71(2):203-7
references: 9139843
references: Eur J Obstet Gynecol Reprod Biol. 1980 Oct;11(2):109-14
references: 7192655
references: Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):823-30
references: 7790270
references: Cancer. 2008 Dec 15;113(12):3349-54
references: 18988288
references: Acta Neurochir (Wien). 2004 Dec;146(12):1287-91; discussion 1291-2
references: 15338336
references: Magn Reson Imaging Clin N Am. 1994 May;2(2):309-17
references: 7489290
references: Neuro Oncol. 2012 Jun;14(6):768-76
references: 22513749
references: Am J Forensic Med Pathol. 1995 Jun;16(2):168-71
references: 7572877
references: Neurol Clin. 2012 Aug;30(3):937-46
references: 22840798
references: Rev Neurol (Paris). 2006 Mar;162(3):322-9
references: 16585887
references: Int J Obstet Anesth. 2009 Jan;18(1):52-4
references: 18996002
references: Ann Neurol. 2010 Mar;67(3):398-404
references: 20373352
references: Neurol India. 2003 Mar;51(1):129-30
references: 12865552
references: J Clin Neurosci. 1996 Oct;3(4):334-7
references: 18638898
references: J Gynecol Obstet Biol Reprod (Paris). 1993;22(1):71-80
references: 8463571
references: Clin Cancer Res. 2010 Aug 1;16(15):3851-9
references: 20534737
references: Can J Anaesth. 1994 Feb;41(2):163-4
references: 8131237
references: Tunis Med. 2010 Jun;88(6):450-1
references: 20517862
references: J Med Imaging Radiat Oncol. 2009 Dec;53(6):559-68
references: 20002289
references: Mil Med. 1989 Jun;154(6):330-1
references: 2498772
references: Neurosurgery. 2012 Sep;71(3):729-39; discussion 739-40
references: 22668885
references: Int J Gynaecol Obstet. 2009 Apr;105(1):56-9
references: 19155008
references: Arch Neurol. 1987 Feb;44(2):209-15
references: 3545159
references: Br J Neurosurg. 2011 Aug;25(4):478-87
references: 21344977
references: Ann Oncol. 2010 May;21 Suppl 5:v190-3
references: 20555079
references: J Matern Fetal Neonatal Med. 2005 Jan;17(1):81-3
references: 15804792
references: Clin Oncol (R Coll Radiol). 2012 May;24(4):311
references: 22449791
references: Ann Acad Med Singap. 2010 Jan;39(1):64-5
references: 20126819
references: Cancer Epidemiol Biomarkers Prev. 2010 Oct;19(10):2562-9
references: 20802020
references: J Neurosurg. 2012 Jun;116(6):1187-94
references: 22404670
references: Anaesthesia. 1986 Nov;41(11):1128-9
references: 3024523
references: Am J Obstet Gynecol. 2000 May;182(5):1215-21
references: 10819861
references: Obstet Gynecol. 1997 Jan;89(1):19-23
references: 8990430
references: J Neurol. 2009 Dec;256(12):2014-20
references: 19763385
references: Eur J Neurol. 2010 Sep;17(9):1124-1133
references: 20718851
references: Cancer Res. 1980 Dec;40(12):4519-23
references: 6254647
references: Clin Obstet Gynecol. 2005 Mar;48(1):24-37
references: 15725854