Management of high-grade glioma in pregnancy: Case report and review of the literature

Although high-grade gliomas most commonly present in older individuals, they infrequently present in women of childbearing age. We report the case of a 27-year-old woman previously diagnosed with a grade 4 astrocytoma who became pregnant during treatment. The patient had a stable pregnancy until the perinatal period, when she experienced worsening headache, nausea, and vomiting, and was confirmed to have disease recurrence. Labor was induced at the 37th week of gestation with delivery of a healthy neonate. With the low incidence of high-grade gliomas in the pregnant population and resulting paucity of literature, there is no consensus on the treatment strategy for this population. To better characterize this disease process and investigate the optimal management of these challenging cases, we reviewed the literature and identified 81 cases of high-grade gliomas in pregnant individuals, but we were unable to identify any factors associated with increased survival. We discuss topics of importance to physicians managing these complex cases and make suggestions for the management of common issues for this patient population.