Management of brain tumours in pregnancy

Key message: Pregnant women diagnosed with brain tumours face unique challenges due to the physiological and hormonal changes of pregnancy, which can exacerbate tumour growth and symptoms. A multidisciplinary approach involving neurosurgeons, obstetricians, and other specialists is essential for optimising maternal and foetal outcomes.
•    Diagnosis: Symptoms such as headache, nausea, vomiting, and seizures may overlap with typical pregnancy discomforts, making detailed neurological and imaging assessments crucial.
•    Management: Treatment strategies are individualised based on the tumour type, size, location, and pregnancy stage. Options include:
    - Conservative management with regular monitoring.
    - Surgical intervention, preferably in the second trimester, for cases with severe symptoms or rapid tumour growth.
    - Steroid therapy to manage tumour-induced oedema and support foetal lung maturation in cases of preterm delivery.
    - Antiepileptic medications and other symptom-specific therapies are used when necessary, though care is taken to minimise foetal exposure to teratogenic drugs.
•    Timing of Delivery: Caesarean section is often preferred to avoid the risk of increased intracranial pressure during vaginal delivery. In cases requiring surgery near term, simultaneous caesarean delivery and neurosurgery may be considered.
•    Postpartum Care: Post-surgical and post-treatment monitoring is critical, especially for potential complications like pituitary suppression or the need for further cancer therapy. Fertility preservation techniques and counselling should be considered for women undergoing chemotherapy or radiotherapy before pregnancy.
•    Prognosis: Outcomes depend on tumour type, timing of diagnosis, and prompt management. Preconceptual optimisation for women with a history of brain tumours may improve obstetric outcomes and reduce the risks associated with tumour progression during pregnancy.