Fertility and pregnancy considerations in patients with glioma: a review of current guidelines and evidence gaps

Abstract

Gliomas are among the most common primary CNS tumors in adolescents and young adults (AYAs; ages 15–39 years), and several subtypes are associated with prolonged survival. As a result, fertility preservation and pregnancy management have become increasingly important components of survivorship care; however, current evidence remains scarce. Despite family planning needs, many patients receive limited counselling, and both referral to and access to reproductive specialists remains inconsistent. Glioma‑directed therapies may impair fertility through gonadotoxic chemotherapy, hypothalamic–pituitary dysfunction, or prolonged exposure to targeted agents with poorly defined reproductive effects. Pregnancy after glioma diagnosis introduces additional complexities, including concerns regarding tumor progression, optimal timing of conception, antiseizure medication selection, and obstetric and neonatal risks. Evidence describing the interaction between pregnancy and glioma biology is limited to small retrospective series with heterogeneous imaging practices and minimal molecular characterization. Available data suggest that tumor behavior during pregnancy largely reflects underlying histology, grade, and prior treatment, with progression more frequently reported in higher‑grade disease and transient increases in growth kinetics described in some IDH‑mutant diffuse gliomas. Overall survival does not appear adversely affected by pregnancy. This review synthesizes current guidelines and evidence across fertility preservation, preconception planning, and cancer management during pregnancy, emphasizing multidisciplinary care and highlighting key evidence gaps—particularly regarding targeted therapies, optimal surveillance, and molecularly informed risk stratification—to guide future research and clinical practice.