By Dr. Sathyanarayana L D, Consultant neurosurgeon, Narayana Health, Bengaluru
Pregnancy is usually a time filled with happiness and hope, plans for the new addition to the family, and pampering. But for some expecting moms, that journey can be jolted by an unexpected and infrequent diagnosis — one of a brain tumour.
Pregnancy already brings significant physical changes, emotional ups and downs, and constant monitoring of health. The presence of a brain tumour during this time turns the situation into one of the most complex medical scenarios a person can face. Two lives are at stake in such cases, and every decision must be made with caution, deliberation, and careful consideration.
Diagnosis and Initial Assessment
Identifying a brain tumour diagnosis in a pregnant woman is particularly challenging because many of the symptoms of brain tumours usually share common physiological changes and discomforts associated with pregnancy. Nausea, vomiting, persistent headaches, and dizziness are common during pregnancy, but they are also key warning signals of a brain tumour.
This overlap often leads to misdiagnosis or delay in diagnosis, as medical professionals may initially attribute the symptoms to pregnancy-related discomfort. When these symptoms persist or worsen, imaging is used to confirm the diagnosis.
Magnetic Resonance Imaging (MRI)is the preferred method, as it provides detailed images without radiation and is considered safe during pregnancy. In some cases, additional tests or a biopsy may be required if the type of tumour is unclear.
Computed Tomography (CT) scans are generally avoided during pregnancy as they use ionising radiation, which is a risk to the foetus.
Diagnosis of brain tumours during pregnancy is typically established through a multidisciplinary approach involving obstetricians, neurologists, and radiologists. Once the type of tumour is confirmed, the medical team considers several key questions:
- Is it a low-grade or a high-grade tumour?
- Is it causing pressure on the brain?
- How far along is the pregnancy?
Tumours that are slow growing, such as meningiomas, may be monitored closely until it is safe to give treatment (particularly either in the second trimester or after delivery). More aggressive tumours like glioblastomas may require immediate action, even in early pregnancy.
Impact of Pregnancy on Tumours
Pregnancy causes major physiological changes in a woman, including increased levels of hormones like oestrogen and a rise in blood volume. These changes can, in some cases, accelerate the growth of the tumour.
Treatment Considerations
Treatment of brain tumours in pregnancy requires a multidisciplinary approach that carefully considers the safety and health of both the mother and the foetus. Treatment plans are highly individualised and depend on several factors, including the type and location of the tumour, its rate of growth, the patient’s symptoms, and the stage of pregnancy.
Surgery is often recommended if the tumour is causing increasing intracranial pressure, bleeding, or severe symptoms. The second trimester is considered to be the safest period for a surgery, as the risk to the foetus is lower than in the first trimester and the uterus is not yet large enough to complicate things.
If the patient is in the third trimester, doctors may consider scheduling an early delivery (typically between 32 to 36 weeks) so that surgery or additional treatment can begin promptly afterward.
Chemotherapy and radiation therapy are typically delayed until after delivery unless the situation is urgent. Some chemotherapy agents may be used during the second or third trimester with caution, but they are usually avoided in the first trimester due to the high risk of birth defects.
Delivery Considerations
Delivery planning in this context involves careful coordination among obstetricians, neurosurgeons, and anaesthesiologists. When and how to schedule the delivery depends on several factors:
Timing
- If the tumour is stable and not causing significant symptoms, delivery may proceed at full term (around 39 to 40 weeks).
- If the tumour is aggressive or the mother’s condition is worsening, an early delivery (32 to 36 weeks) may be recommended to allow prompt treatment.
- In the case of a medical emergency, such as seizures or brain swelling, an emergency delivery may be performed at any gestational age to protect the mother’s life.
Mode of delivery
- If the tumour affects the mother’s ability to safely go through labour—for example, due to increased intracranial pressure—then a C-section is usually recommended to minimise the risk of complications during delivery.
- If the tumour is small and not causing pressure-related symptoms, vaginal delivery may still be an option.
Psychological considerations
A brain tumour diagnosis is inherently a life-changing and traumatic event. When it occurs during pregnancy, it introduces an additional layer of emotional and psychological distress. This can impact the overall well-being of the patient.
Patients commonly experience:
- Heightened anxiety
- Depression
- Guilt or fear about the baby’s future
- Emotional isolation
Recognising and addressing these emotional needs is essential. Mental health support—through counselling, support groups, or psychiatric care—should be an integral part of treatment.
Conclusion
A brain tumour diagnosis during pregnancy presents one of the most complex, rare, and emotionally challenging medical scenarios. It requires highly individualised care, constant re-evaluation, and a coordinated effort across multiple specialities.
With thoughtful planning and compassionate support, it is possible to protect the health of both the mother and the baby. The path may be difficult, but patients do not have to face it alone; with the right care, there is hope for a safe outcome.