The risk of developing a meningioma during and after pregnancy

Jenny Pettersson-Segerlind,Giorgio Tettamanti,Tiit Mathiesen,Erik Edström,Adrian Elmi-Terander,Mats Talbäck,Maria Feychting

doi:10.1038/s41598-021-88742-2

Abstract

Pregnancy has been associated with diagnosis or growth of meningiomas in several case reports, which has led to the hypothesis that pregnancy may be a risk factor for meningiomas. The aim of this study was to test this hypothesis in a large population-based cohort study. Women born in Sweden 1958–2000 (N = 2,204,126) were identified and matched with the Medical Birth Register and the Cancer Register. The expected number of meningioma cases and risk ratios were calculated for parous and nulliparous women and compared to the observed number of cases. Compared to parous women, meningiomas were more common among nulliparous (SIR = 1.73; 95% CI 1.52–1.95). The number of meningioma cases detected during pregnancy was lower than the expected (SIR = 0.40; 95% CI 0.20–0.72). Moreover, no increased risk was found in the first-year post-partum (SIR = 1.04; 95% CI 0.74–1.41). Contrary to our hypothesis, there was no increased risk for diagnosing a meningioma during pregnancy or 1-year post-partum. A lower detection rate during pregnancy, may reflect under-utilization of diagnostic procedures, but the actual number of meningiomas was homogenously lower among parous than nulliparous women throughout the study period, indicating that pregnancy is not a risk factor for meningioma.

Highlights

Pregnancy has been associated with diagnosis or growth of meningiomas in several case reports, which has led to the hypothesis that pregnancy may be a risk factor for meningiomas
In this population-based cohort study, the aim was to study the relation between giving birth and meningiomas in women during the fertile and reproductive years, the risk of having a meningioma diagnosed during pregnancy and during the first 20 years postpartum, as well as the risk of meningioma among nulliparous women
During the follow-up period 1973–2015 there were 2,353,894 births, and 1,129,484 women had at least one delivery, 1173 women were diagnosed with meningioma, and 21,953 women died during follow-up

Summary

Introduction

Pregnancy has been associated with diagnosis or growth of meningiomas in several case reports, which has led to the hypothesis that pregnancy may be a risk factor for meningiomas. With its extensive hormonal changes, could be a risk factor for meningioma development or growth given the epidemiological associations with hormone levels. Progesterone signaling is mitogenic in breast c ancer[21] and progesterone increases sensitivity of meningioma cells to mitogenic s timuli[22] In agreement with this hypothesis, cases of rapid meningioma growth during pregnancy, sometimes even followed by spontaneous involution post-partum, have been described since meningiomas were first classified[23,24,25]. Wigertz et al found a correlation between the risk of a meningioma and three or more live births among women younger than 50 years, in a case-control study[5], while other studies have been negative[10,13]. In this population-based cohort study, the aim was to study the relation between giving birth and meningiomas in women during the fertile and reproductive years, the risk of having a meningioma diagnosed during pregnancy and during the first 20 years postpartum, as well as the risk of meningioma among nulliparous women

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