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BRAIN TUMORS The incidence of brain neoplasms does not increase during pregnancy and
the types of tumors are similar to those seen in nonpregnant women of the same age. Low-grade
and high-grade gliomas and meningiomas each represent about one-third of cases. No particular
systemic neoplasm with brain metastases is associated with pregnancy with the exception of
choriocarcinoma, in which approximately 3 to 20 percent of patients have brain metastases at the
time of diagnosis [72]. Meningiomas, vestibular schwannomas (acoustic neuromas), and
pituitary tumors may enlarge during pregnancy and become symptomatic.
The changes that occur during pregnancy can have a significant effect on symptoms and tumor
growth [72-74]. Fluid retention, for example, can increase tumor edema and enlarge vascular
tumors such as meningiomas and vestibular schwannomas [74]. In addition, both meningiomas
and vestibular schwannomas have sex hormone receptors, which may play a role in accelerating
tumor growth during gestation [75]. A study of 12 pregnancies in 11 women with grade II
gliomas, found significant radiologic expansion of the tumor during pregnancy as compared to
prepregnancy and post-delivery time periods [76]. In another small case series of eight patients
with a glioma, pregnancy appeared to be associated with adverse effects (clinical and/or
radiographic worsening) in six [77].
Clinical manifestations Although nausea and vomiting is a common symptom of both
pregnancy and cerebral neoplasms, pregnancy-related nausea and vomiting occurs very early in
pregnancy and tends to improve across gestation, while tumor-related nausea and vomiting is
more likely to arise late in gestation, gradually worsens, and may be accompanied by headache.
New onset of seizures can be a symptom of eclampsia or associated with a brain tumor.
Eclamptic seizures are typically generalized. Tumor-related seizures may be focal and associated
with focal neurologic findings. However, secondary generalization may occur rapidly, and the
focal onset therefore may be unapparent to observers. In one case series, increased seizure
frequency was noted in 5 of 12 pregnancies in women who harbored grade II gliomas [76]. An
overview of the clinical manifestations and diagnosis of brain tumors can be found separately.
(See "Clinical presentation and diagnosis of brain tumors".)
Management The treatment and prognosis of brain neoplasms seen during pregnancy is
highly dependent upon the particular cell type involved, as well as the clinical manifestations and
the stage of pregnancy [78]. Magnetic resonance imaging (MRI), which does not involve
radiation, can be safely performed in the pregnant patient, but gadolinium is typically not
recommended. (See "Diagnostic imaging procedures during pregnancy".)
Surgery during pregnancy is indicated in patients with malignant tumors or tumors causing
severe symptoms [78]. Brain irradiation when indicated may be performed during pregnancy.
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73. Simon RH. Brain tumors in pregnancy. Semin Neurol 1988; 8:214.
74. Michelsen JJ, New PF. Brain tumour and pregnancy. J Neurol Neurosurg Psychiatry
1969; 32:305.
75. Carroll RS, Zhang J, Black PM. Expression of estrogen receptors alpha and beta in
human meningiomas. J Neurooncol 1999; 42:109.
76. Pallud J, Mandonnet E, Deroulers C, et al. Pregnancy increases the growth rates of World
Health Organization grade II gliomas. Ann Neurol 2010; 67:398.
77. Pallud J, Duffau H, Razak RA, et al. Influence of pregnancy in the behavior of diffuse
gliomas: clinical cases of a French glioma study group. J Neurol 2009; 256:2014.
78. Ng J, Kitchen N. Neurosurgery and pregnancy. J Neurol Neurosurg Psychiatry 2008;
79:745.
79. Stevenson CB, Thompson RC. The clinical management of intracranial neoplasms in
pregnancy. Clin Obstet Gynecol 2005; 48:24.
80. MARX GF, ZEMAITIS MT, ORKIN LR. Cerebrospinal fluid pressures during labor and
obstetrical anesthesia. Anesthesiology 1961; 22:348.
81. Finfer SR. Management of labour and delivery in patients with intracranial neoplasms. Br
J Anaesth 1991; 67:784.
82. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice.
Committee Opinion No. 656: Guidelines for Diagnostic Imaging During Pregnancy and
Lactation. Obstet Gynecol 2016; 127:e75.