Pregnancy and brain tumors; a systematic review of the literature

Molina-Botello, Diego; Rodríguez-Sanchez, Jesus René; Cuevas-García, Jesús; Cárdenas-Almaraz, Bárbara Victoria; Morales-Acevedo, José Adrián; Mejía-Pérez, Sonia Iliana; Ochoa-Martínez, Edith Elizabeth

doi:10.1016/j.jocn.2021.01.048

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…But certain factors such as immunological tolerance, hormone-mediated growth, and hemodynamic changes may promote neoplasm growth mediating a common pathway to increasing intracranial mass effect (3,4,6). Intracranial tumors usually initially present with symptoms and signs of increased intracranial pressure such as headache, dizziness, or vomiting, related focal neurological deficits and seizures, which are often confused with pregnancy itself, hypertensive disorders and thrombosis in pregnancy (7). Many of patients are misdiagnosed and fail to receive timely treatment.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: A Pregnant Woman Diagnosed as ALK-Rearrangement Lung Large Cell Neuroendocrine Cancer With Brain Metastasis

Zhu

Wang

et al. 2022

Front. Oncol.

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Concomitant malignant tumors and pregnancy present many difficult questions to both clinicians and patients. Due to no specific guidelines, each aspect of clinical management requires special considerations. This current report presents a rare case of a 38-year-old pregnant woman at gestational age 33 weeks with complaints of weakness of her right limbs for 2 weeks. After successive cesarean section and craniotomy, a diagnosis of lung large cell neuroendocrine carcinoma (LCNEC) metastatic to the brain was eventually made. Next generation sequencing (NGS) showed ALK-EML4 gene fusion. Immediately afterwards she was started on the targeted therapy with the ALK inhibitor alectinib. Ten months later, all known lesions exhibited a rapid regression, and no new brain metastases were found. Consequently, the therapeutic effect was considered as a partial response. Then, we review the previous literature using PubMed on maternal malignant brain tumors diagnosed during pregnancy, or lung LCNEC associated with ALK fusion, or ALK inhibitors treatment among the pregnant women, eventually, and discuss the concerns of dealing with these patients.

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Section: Discussionmentioning

confidence: 99%

“…Although long-term steroid use can contribute to neonatal hypoadrenalism, it is an uncommon complication (10). Mannitol has a risk of affecting fetal circulation, and doses of 0.5-1 g/kg are considered safe (7). Additionally, prophylactic use of antiepileptic drugs is not recommended because of their teratogenicity.…”

Section: Discussionmentioning

confidence: 99%

Case Report: A Pregnant Woman Diagnosed as ALK-Rearrangement Lung Large Cell Neuroendocrine Cancer With Brain Metastasis

Zhu

Wang

et al. 2022

Front. Oncol.

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“…Meningiomas likewise have been shown to grow faster during the luteal phase of menstruation [8]. It was long thought that pregnancy also increased the incidence of meningiomas, although this has shown to not be the case, with the incidence of meningioma either similar or decreased [7,12,13]. A 2021 study by Pettersson-Segerlind et al utilized the Swedish National Population Registry and compared the risk of developing a meningioma both during and after pregnancy [13].…”

Section: Discussionmentioning

confidence: 99%

“…The American College of Obstetricians and Gynecologists (ACOG) recommends that a pregnant woman should not be denied or delayed necessary surgery regardless of trimester. However, unfortunately, no guidelines exist on the best management of meningioma in pregnancy, which can make prenatal and peripartum care more difficult [1,7,12]. The diagnosis and severity of meningioma during pregnancy can be challenging.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis and severity of meningioma during pregnancy can be challenging. Symptoms of high intracranial pressure, such as vomiting, may be misconstrued as hyperemesis gravidarium and seizure activity, which can occur from eclampsia or from a tumor [7,12]. Furthermore, a head computed tomography (CT) scan is unlikely to be pursued during pregnancy due to the effects of radiation.…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy and Childbirth in Women With Meningioma

Hallan¹,

Bhanja²,

Sciscent³

et al. 2022

Cureus

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BackgroundTen percent of women of childbearing age have histologically confirmed meningioma. To date, little is known regarding pregnancy-related outcomes for women with meningioma. MethodsWe used a de-identified database network (TriNetX's Research Network, https://trinetx.com/) to gather information on pregnant patients with meningioma (cohort 1) versus pregnant patients without meningioma (cohort 2). The primary outcome of interest included the impact of meningioma on mortality at one year. Secondary endpoints included ectopic or molar pregnancy, cesarean section, abortion, preterm labor, depression, pre-eclampsia/eclampsia, and craniotomy. Odds ratios (OR) with 95% confidence intervals (CI) were used to measure levels of association between each cohort and the outcomes of interest. ResultsA total of 1,739 patients were identified in each cohort following propensity-score matching. Mortality was seen in 23 patients (1.32%) in cohort 1 versus 26 patients (1.41%) in cohort 2 (OR 0.88, 95% CI {0.50, 1.55}, p=0.66). Ectopic/ molar pregnancy was seen in 31 (1.78%) versus 42 (2.42%) patients in cohorts 1 and 2, respectively (OR 0.73, 95% CI {0.046,1.17}, p=0.19). Cesarean section was seen in 126 (7.25%) versus 164 (9.43%) patients, respectively (OR 0.75, 95% CI {0.59,0.97}, p=0.020). Abortion was seen in 128 (7.36%) versus 183 (10.52%) patients, respectively (OR 0.68, 95% CI {0.53,0.86}, p=0.0011). Preterm labor was seen in 75 (4.31%) versus 119 (6.84%) patients, respectively (OR 0.61, 95% CI {0.46,0.83}, p=0.0012). Depression was seen in 258 (14.84%) versus 270 (15.53%) patients, respectively (OR 0.95, 95% CI {0.79,1.14}, p=0.57). Preeclampsia/eclampsia was seen in 3.11% versus 5.52% patients, respectively (OR 0.55, 95% CI {0.39,0.77}, p=0.0005). Craniotomy was seen in 74 (4.26%) versus 0 (0%) patients in cohort 1 and cohort 2, respectively. ConclusionPatients with meningioma were not at higher risk for pregnancy complications, including ectopic/molar pregnancy, cesarean section, abortion, preterm labor, pre-eclampsia/eclampsia, and mortality, compared to their non-meningioma counterparts. Still, coordinated care by neurosurgical and obstetrical providers may benefit women with meningiomas who are planning for pregnancy or are currently pregnant.

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