PURPOSE OF REVIEW: This article discusses current recommendations and special considerations for the management of central nervous system (CNS) tumors in pregnant women and provides case vignettes to emphasize important clinical concepts. RECENT FINDINGS: Given that nearly 60% of all intracranial and spinal cord tumors, including both primary and metastatic tumor types, malignant or benign, are diagnosed in women, it is equitable to bring attention to the unique management considerations that pertain to women during specific phases of their lifespan, such as pregnancy. The pregnancy phase is marked by changes in hormonal, immunologic, and other physiologic responses. Although substantial evidence supports a pregnancy influence on tumor oncogenicity, the cumulative effect of the pregnancy state on brain tumor biology remains elusive. Furthermore, as innovative cancer treatments and surveillance technologies expand, providers must consider potential new risks to safe pregnancy maintenance. This article reviews pregnancy considerations in CNS tumor care and offers best practice approaches and considerations. SUMMARY: Informed neuro-oncology practices on safer surgical, radiation, medical, device, and imaging techniques is of critical importance to pregnancy and fertility maintenance in cancer survivors. Expanding this knowledge relies on advocacy and a commitment to develop equitable and multidisciplinary research within the field. This also requires a focus on patient-reported outcomes and patient-centered conversations to best care for pregnant women with CNS tumors.