Neuro-Oncological Management of Gliomas in Pregnancy: A Systematic Review of the Literature

Purpose of ReviewThe management of gliomas during pregnancy poses significant challenges for the health care provider who looks after the mother and fetus. Due to the rarity of these tumors and paucity of high-quality data as well as absence of level 1/2 evidence, standardized treatment guidelines remain scant. To address this knowledge gap, a systematic search was conducted between 1990 and 2024 across PubMed and Embase databases in accordance with PRISMA guidelines. It included case reports, case series, and cohort studies that reported on patients diagnosed with gliomas before, during, or shortly after pregnancy. We analyzed this data set with respect to the mother’s neurological status peripartum, the delivery mode of the baby as well as the maternal and fetal outcome in light of the histopathology, radiographic data as well as treatment provided.FindingsAfter application of study criteria, a total of 36 studies were identified including 389 patients diagnosed with gliomas prior to (n = 196) or during pregnancy (n = 193). Of these, 9 studies included non-glioma brain tumor patients as well as glioma patients. WHO tumor grade across the pooled cohort ranged from I to IV. Treatment recommendations were derived from observational studies and expert opinions.SummaryPregnancy did not appear to affect survival rates of patients with low-grade gliomas. However, it may affect tumor behavior as manifest by a reported increase in tumor growth. For high-grade glioma patients, however, pregnancy did appear to pose significant risk due to an inability to complete treatment protocols and poor adherence to treatment leading to increased morbidity and premature death. Most experts advise against pregnancy in this setting. If a glioma patient becomes pregnant, current literature shows that cesarean delivery does not offer any advantage over attempted vaginal delivery. A multidisciplinary approach is crucial for optimal management of pregnant patients with a previously or newly diagnosed glioma.