Acta Neurochirurgica

, Volume 161, Issue 3, pp 535–543 | Cite as

Influence of pregnancy on glioma patients

  • Marie-Therese ForsterEmail author
  • Peter Baumgarten
  • Florian Gessler
  • Gabriele Maurer
  • Christian Senft
  • Elke Hattingen
  • Volker Seifert
  • Patrick N. Harter
  • Kea Franz
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors



Data about the influence of pregnancy on progression-free survival and overall survival of glioma patients are sparse and controversial. We aimed at providing further evidence on this relation.


The course of 18 glioma patients giving birth to 23 children after tumor surgery was reviewed and compared to the course of 18 nulliparous female patients matched for tumor diagnosis including molecular markers, extent of resection, and tumor location.


Tumor pathology was astrocytoma, oligodendroglioma, and ependymoma in 9, 6, and 3 patients, respectively. Time interval between tumor resection and delivery was 5.3 ± 4.4 years. All newborns were healthy after uneventful deliveries. Tumor progression was diagnosed before pregnancy in 4 patients and during pregnancy in 1 patient, and 4 patients displayed progressive disease 31.0 ± 11 months after delivery. Three of these latter patients underwent second surgery, whereas resection of recurrent tumor had been performed in 2 women before pregnancy. Among nulliparous patients, 9 women suffered from tumor progression, resulting in re-operation in 7 patients and/or further adjuvant treatment in 6 cases. Progression-free survival did not differ between patients with and patients without children (p = 0.4). Moreover, in both groups, median overall survival was not reached after a mean follow-up period of 9.7 ± 5.7 years in glioma patients who gave birth to a child and 8.9 ± 4.2 years in nulliparous glioma patients.


Pregnancy does not seem to influence the clinical course of glioma patients. Likewise, glioma seems not to have an impact on delivered children’s health.


Brain tumor Glioma Matched-pairs analysis Pregnancy 



The authors thank Prof. Dr. Eva Herrmann for her help with statistics.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the University Hospital Frankfurt) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Altinoz MA, Ozpinar A, Elmaci I (2018) Reproductive epidemiology of glial tumors may reveal novel treatments: high-dose progestins or progesterone antagonists as endocrino-immune modifiers against glioma. Neurosurg Rev.
  2. 2.
    Anic GM, Madden MH, Nabors LB, Olson JJ, LaRocca RV, Thompson ZJ, Pamnani SJ, Forsyth PA, Thompson RC, Egan KM (2014) Reproductive factors and risk of primary brain tumors in women. J Neuro-Oncol 118:297–304. CrossRefGoogle Scholar
  3. 3.
    Baumert BG, Hegi ME, van den Bent MJ, von Deimling A, Gorlia T, Hoang-Xuan K, Brandes AA, Kantor G, Taphoorn MJ, Hassel MB, Hartmann C, Ryan G, Capper D, Kros JM, Kurscheid S, Wick W, Enting R, Reni M, Thiessen B, Dhermain F, Bromberg JE, Feuvret L, Reijneveld JC, Chinot O, Gijtenbeek JM, Rossiter JP, Dif N, Balana C, Bravo-Marques J, Clement PM, Marosi C, Tzuk-Shina T, Nordal RA, Rees J, Lacombe D, Mason WP, Stupp R (2016) Temozolomide chemotherapy versus radiotherapy in high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. Lancet Oncol 17:1521–1532. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Blumenthal DT, Parreno MG, Batten J, Chamberlain MC (2008) Management of malignant gliomas during pregnancy: a case series. Cancer 113:3349–3354. CrossRefPubMedGoogle Scholar
  5. 5.
    Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ Jr (2016) Radiation plus procarbazine, CCNU, and vincristine in low-grade glioma. N Engl J Med 374:1344–1355. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Capelle L, Fontaine D, Mandonnet E, Taillandier L, Golmard JL, Bauchet L, Pallud J, Peruzzi P, Baron MH, Kujas M, Guyotat J, Guillevin R, Frenay M, Taillibert S, Colin P, Rigau V, Vandenbos F, Pinelli C, Duffau H, French Reseau d'Etude des G (2013) Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg 118:1157–1168. CrossRefPubMedGoogle Scholar
  7. 7.
    Chang EF, Smith JS, Chang SM, Lamborn KR, Prados MD, Butowski N, Barbaro NM, Parsa AT, Berger MS, McDermott MM (2008) Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:817–824. CrossRefPubMedGoogle Scholar
  8. 8.
    Claus EB, Black PM (2006) Survival rates and patterns of care for patients diagnosed with supratentorial low-grade gliomas: data from the SEER program, 1973-2001. Cancer 106:1358–1363. CrossRefPubMedGoogle Scholar
  9. 9.
    Committee on Obstetric P (2017) Committee opinion no. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol 130:e210–e216. CrossRefGoogle Scholar
  10. 10.
    Corell A, Carstam L, Smits A, Henriksson R, Jakola AS (2018) Age and surgical outcome of low-grade glioma in Sweden. Acta Neurol Scand.
  11. 11.
    Cowppli-Bony A, Bouvier G, Rue M, Loiseau H, Vital A, Lebailly P, Fabbro-Peray P, Baldi I (2011) Brain tumors and hormonal factors: review of the epidemiological literature. Cancer Causes Control 22:697–714. CrossRefPubMedGoogle Scholar
  12. 12.
    Daras M, Cone C, Peters KB (2014) Tumor progression and transformation of low-grade glial tumors associated with pregnancy. J Neuro-Oncol 116:113–117. CrossRefGoogle Scholar
  13. 13.
    Ellingson BM, Wen PY, Cloughesy TF (2017) Modified criteria for radiographic response assessment in glioblastoma clinical trials. Neurotherapeutics 14:307–320. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Evans AC, Nelson MB, Dhall G (2015) Pregnancy in a patient with a malignant brain tumor taking temozolomide: case report and review of the literature. J Pediatr Oncol Nurs 32:326–328. CrossRefPubMedGoogle Scholar
  15. 15.
    Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgard G, Solheim O (2012) Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 308:1881–1888. CrossRefPubMedGoogle Scholar
  16. 16.
    Jungk C, Scherer M, Mock A, Capper D, Radbruch A, von Deimling A, Bendszus M, Herold-Mende C, Unterberg A (2016) Prognostic value of the extent of resection in supratentorial WHO grade II astrocytomas stratified for IDH1 mutation status: a single-center volumetric analysis. J Neuro-Oncol 129:319–328. CrossRefGoogle Scholar
  17. 17.
    Lan YL, Wang X, Lou JC, Ma BB, Xing JS, Zou S, Zhang B (2018) Update on the effect of exogenous hormone use on glioma risk in women: a meta-analysis of case-control and cohort studies. J Neuro-Oncol 137:357–365. CrossRefGoogle Scholar
  18. 18.
    Lawrenz B, Mahajan N, Fatemi HM (2016) The effects of cancer therapy on women’s fertility: what do we know now? Future Oncol 12:1721–1729. CrossRefPubMedGoogle Scholar
  19. 19.
    Michaud DS, Gallo V, Schlehofer B, Tjonneland A, Olsen A, Overvad K, Dahm CC, Kaaks R, Lukanova A, Boeing H, Schutze M, Trichopoulou A, Bamia C, Kyrozis A, Sacerdote C, Agnoli C, Palli D, Tumino R, Mattiello A, Bueno-de-Mesquita HB, Ros MM, Peeters PH, van Gils CH, Lund E, Bakken K, Gram IT, Barricarte A, Navarro C, Dorronsoro M, Sanchez MJ, Rodriguez L, Duell EJ, Hallmans G, Melin BS, Manjer J, Borgquist S, Khaw KT, Wareham N, Allen NE, Tsilidis KK, Romieu I, Rinaldi S, Vineis P, Riboli E (2010) Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study. Cancer Epidemiol Biomark Prev 19:2562–2569. CrossRefGoogle Scholar
  20. 20.
    Pallud J, Duffau H, Razak RA, Barbarino-Monnier P, Capelle L, Fontaine D, Frenay M, Guillet-May F, Mandonnet E, Taillandier L (2009) Influence of pregnancy in the behavior of diffuse gliomas: clinical cases of a French glioma study group. J Neurol 256:2014–2020. CrossRefPubMedGoogle Scholar
  21. 21.
    Pallud J, Mandonnet E, Deroulers C, Fontaine D, Badoual M, Capelle L, Guillet-May F, Page P, Peruzzi P, Jouanneau E, Frenay M, Cartalat-Carel S, Duffau H, Taillandier L, Club de Neuro-Oncologie de la Societe Francaise de N, Association des Neuro-Oncologues d’Expression F (2010) Pregnancy increases the growth rates of World Health Organization grade II gliomas. Ann Neurol 67:398–404. CrossRefPubMedGoogle Scholar
  22. 22.
    Peeters S, Pages M, Gauchotte G, Miquel C, Cartalat-Carel S, Guillamo JS, Capelle L, Delattre JY, Beauchesne P, Debouverie M, Fontaine D, Jouanneau E, Stecken J, Menei P, De Witte O, Colin P, Frappaz D, Lesimple T, Bauchet L, Lopes M, Bozec L, Moyal E, Deroulers C, Varlet P, Zanello M, Chretien F, Oppenheim C, Duffau H, Taillandier L, Pallud J, for the Club de Neuro-Oncologie de la Societe Francaise de N, the Association des Neuro-Oncologues d'Expression F (2018) Interactions between glioma and pregnancy: insight from a 52-case multicenter series. J Neurosurg 128:3–13. CrossRefPubMedGoogle Scholar
  23. 23.
    Qi ZY, Shao C, Zhang X, Hui GZ, Wang Z (2013) Exogenous and endogenous hormones in relation to glioma in women: a meta-analysis of 11 case-control studies. PLoS One 8:e68695. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Roelz R, Strohmaier D, Jabbarli R, Kraeutle R, Egger K, Coenen VA, Weyerbrock A, Reinacher PC (2016) Residual tumor volume as best outcome predictor in low grade glioma—a nine-years near-randomized survey of surgery vs biopsy. Sci Rep 6:32286. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ronning PA, Helseth E, Meling TR, Johannesen TB (2016) The effect of pregnancy on survival in a low-grade glioma cohort. J Neurosurg 125:393–400. CrossRefPubMedGoogle Scholar
  26. 26.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345. CrossRefGoogle Scholar
  27. 27.
    van den Bent MJ, Wefel JS, Schiff D, Taphoorn MJ, Jaeckle K, Junck L, Armstrong T, Choucair A, Waldman AD, Gorlia T, Chamberlain M, Baumert BG, Vogelbaum MA, Macdonald DR, Reardon DA, Wen PY, Chang SM, Jacobs AH (2011) Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomas. Lancet Oncol 12:583–593. CrossRefPubMedGoogle Scholar
  28. 28.
    van Westrhenen A, Senders JT, Martin E, DiRisio AC, Broekman MLD (2018) Clinical challenges of glioma and pregnancy: a systematic review. J Neuro-Oncol.
  29. 29.
    Wijnenga MMJ, Mattni T, French PJ, Rutten GJ, Leenstra S, Kloet F, Taphoorn MJB, van den Bent MJ, Dirven CMF, van Veelen ML, Vincent A (2017) Does early resection of presumed low-grade glioma improve survival? A clinical perspective. J Neuro-Oncol 133:137–146. CrossRefGoogle Scholar
  30. 30.
    Wijnenga MMJ, French PJ, Dubbink HJ, Dinjens WNM, Atmodimedjo PN, Kros JM, Smits M, Gahrmann R, Rutten GJ, Verheul JB, Fleischeuer R, Dirven CMF, Vincent A, van den Bent MJ (2018) The impact of surgery in molecularly defined low-grade glioma: an integrated clinical, radiological, and molecular analysis. Neuro-Oncology 20:103–112. CrossRefPubMedGoogle Scholar
  31. 31.
    Yust-Katz S, de Groot JF, Liu D, Wu J, Yuan Y, Anderson MD, Conrad CA, Milbourne A, Gilbert MR, Armstrong TS (2014) Pregnancy and glial brain tumors. Neuro-Oncology 16:1289–1294. CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Zwinkels H, Dorr J, Kloet F, Taphoorn MJ, Vecht CJ (2013) Pregnancy in women with gliomas: a case-series and review of the literature. J Neuro-Oncol 115:293–301. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Marie-Therese Forster
    • 1
    • 2
    Email author
  • Peter Baumgarten
    • 1
  • Florian Gessler
    • 1
  • Gabriele Maurer
    • 2
    • 3
  • Christian Senft
    • 1
    • 2
  • Elke Hattingen
    • 4
  • Volker Seifert
    • 1
    • 2
  • Patrick N. Harter
    • 2
    • 5
    • 6
  • Kea Franz
    • 1
    • 2
  1. 1.Department of NeurosurgeryGoethe University HospitalFrankfurt am MainGermany
  2. 2.University Cancer Center Frankfurt (UCT), Goethe University HospitalFrankfurtGermany
  3. 3.Dr. Senckenberg Institute of NeurooncologyGoethe University HospitalFrankfurt am MainGermany
  4. 4.Department of NeuroradiologyGoethe University HospitalFrankfurt am MainGermany
  5. 5.Institute of Neurology (Edinger-Institute)Goethe University HospitalFrankfurt am MainGermany
  6. 6.German Cancer Research Center DKFZ Im Neuenheimer Feld 280HeidelbergGermany

Personalised recommendations