title: Interactions between glioma and pregnancy: insight from a 52-case multicenter series.
abstract: OBJECTIVE The goal of this study was to provide insight into the influence of gliomas on gestational outcomes, the impact of pregnancy on gliomas, and the identification of patients at risk. METHODS In this multiinstitutional retrospective study, the authors identified 52 pregnancies in 50 women diagnosed with a glioma. RESULTS For gliomas known prior to pregnancy (n = 24), we found the following: 1) An increase in the quantified imaging growth rates occurred during pregnancy in 87% of cases. 2) Clinical deterioration occurred in 38% of cases, with seizures alone resolving after delivery in 57.2% of cases. 3) Oncological treatments were immediately performed after delivery in 25% of cases. For gliomas diagnosed during pregnancy (n = 28), we demonstrated the following: 1) The tumor was discovered during the second and third trimesters in 29% and 54% of cases, respectively, with seizures being the presenting symptom in 68% of cases. 2) The quantified imaging growth rates did not significantly decrease after delivery and before oncological treatment. 3) Clinical deterioration resolved after delivery in 21.4% of cases. 4) Oncological treatments were immediately performed after delivery in 70% of cases. Gliomas with a high grade of malignancy, negative immunoexpression of alpha-internexin, or positive immunoexpression for p53 were more likely to be associated with tumor progression during pregnancy. Deliveries were all uneventful (cesarean section in 54.5% of cases and vaginal delivery in 45.5%), and the infants were developmentally normal. CONCLUSIONS When a woman harboring a glioma envisions a pregnancy, or when a glioma is discovered in a pregnant patient, the authors suggest informing her and her partner that pregnancy may impact the evolution of the glioma clinically and radiologically. They strongly advise a multidisciplinary approach to management. ■ CLASSIFICATION OF EVIDENCE Type of question: association; study design: case series; evidence: Class IV.
authors.affiliation: 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.|2Paris Descartes University, Sorbonne Paris Cité, Paris.
authors.forename: Sophie
authors.initials: S
authors.lastname: Peeters
authors.affiliation: 2Paris Descartes University, Sorbonne Paris Cité, Paris.|3Department of Neuropathology, Sainte-Anne Hospital, Paris.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Pagès
authors.affiliation: 4Department of Pathology, CHU Nancy.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gauchotte
authors.affiliation: 5Department of Pathology, Saint-Louis Hospital, Paris.
authors.forename: Catherine
authors.initials: C
authors.lastname: Miquel
authors.affiliation: 6Department of Neuro-oncology, Hospices Civils de Lyon, Hôpital Neurologique, Bron.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Cartalat-Carel
authors.affiliation: 7Department of Neurology, CHU Caen.
authors.forename: Jean-Sébastien
authors.initials: JS
authors.lastname: Guillamo
authors.affiliation: 8Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Laurent
authors.initials: L
authors.lastname: Capelle
authors.affiliation: 9Department of Neuro-oncology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Delattre
authors.affiliation: 10Department of Neuro-oncology, CHU de Nancy, Hospital Central, Nancy.
authors.forename: Patrick
authors.initials: P
authors.lastname: Beauchesne
authors.affiliation: 7Department of Neurology, CHU Caen.
authors.forename: Marc
authors.initials: M
authors.lastname: Debouverie
authors.affiliation: 11Department of Neurosurgery, Centre Hospitalier Universitaire de Nice.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: 12Department of Neurosurgery, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Jouanneau
authors.affiliation: 13Department of Neurosurgery, Regional Hospital, Orléans.
authors.forename: Jean
authors.initials: J
authors.lastname: Stecken
authors.affiliation: 14Department of Neurosurgery, CHU d'Angers,France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Menei
authors.affiliation: 15Laboratory of Experimental Neurosurgery and Multidisciplinary Research Institute, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire-Université Libre de Bruxelles,Belgium.
authors.forename: Olivier
authors.initials: O
authors.lastname: De Witte
authors.affiliation: 16Department of Radiation, Polyclinique Courlancy, Reims.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Philippe
authors.initials: P
authors.lastname: Colin
authors.affiliation: 17Department of Pediatric and Adult Neuro Oncology, Centre Léon Bérard et Institut Hematology Oncology Pediatric, Lyon.
authors.forename: Didier
authors.initials: D
authors.lastname: Frappaz
authors.affiliation: 18Comprehensive Cancer Center and Biotrial, Rennes.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lesimple
authors.affiliation: 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Luc
authors.initials: L
authors.lastname: Bauchet
authors.affiliation: 20Department of Neurosurgery, Argonay Private Hospital, Argonay.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopes
authors.affiliation: 21Department of Medical Oncology, Institut Curie-Hôpital René Huguenin, Saint-Cloud.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bozec
authors.affiliation: 22Institut Claudius Regaud, Département de Radiothérapie, Toulouse.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Moyal
authors.affiliation: 23Université Paris Diderot, IMNC Laboratory, CNRS, Université Paris-Sud, Orsay.
authors.forename: Christophe
authors.initials: C
authors.lastname: Deroulers
authors.affiliation: 2Paris Descartes University, Sorbonne Paris Cité, Paris.|3Department of Neuropathology, Sainte-Anne Hospital, Paris.|26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Varlet
authors.affiliation: 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.|2Paris Descartes University, Sorbonne Paris Cité, Paris.
authors.forename: Marc
authors.initials: M
authors.lastname: Zanello
authors.affiliation: 2Paris Descartes University, Sorbonne Paris Cité, Paris.|3Department of Neuropathology, Sainte-Anne Hospital, Paris.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Chretien
authors.affiliation: 2Paris Descartes University, Sorbonne Paris Cité, Paris.|24Department of Neuroradiology, Sainte-Anne Hospital, Paris.|26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
authors.affiliation: 19Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
authors.affiliation: 7Department of Neurology, CHU Caen.|25Réseau d'Etude des Gliomes, REG, Groland; and.
authors.forename: Luc
authors.initials: L
authors.lastname: Taillandier
authors.affiliation: 1Department of Neurosurgery, Sainte-Anne Hospital, Paris.|2Paris Descartes University, Sorbonne Paris Cité, Paris.|25Réseau d'Etude des Gliomes, REG, Groland; and.|26Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris,France.
authors.forename: Johan
authors.initials: J
authors.lastname: Pallud
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: IGF-1 = insulin-like growth factor–1; VDE = velocity of diametric expansion; glioma management; natural history; oncology; pregnancy