Behçet's disease and pregnancy: retrospective study and updated review of the literature

Behçet's disease (BD) is a rare, chronic-relapsing multisystem vasculitis of unknown aetiology, typically presenting with bipolar aphthosis (oral and genital), cutaneous lesions, and ocular involvement. It is most often diagnosed during reproductive age and its coexistence with pregnancy is therefore not uncommon. The interaction between BD and pregnancy is complex and bidirectional: pregnancy can modulate disease activity, while the disease itself may influence maternal, foetal, and neonatal outcomes. Current literature remains limited and frequently yields inconsistent conclusions regarding this relationship. In light of these considerations, this study aims to evaluate the impact of BD on pregnancy outcomes and to characterise the disease course during pregnancy in a cohort of affected patients.

We retrospectively analysed data from 25 patients with a confirmed diagnosis of BD and a total of 48 pregnancies, followed at the outpatient clinics of Policlinico Umberto I, Rome, Italy. Clinical records were reviewed and supplemented with telephone interviews to ensure accuracy and completeness of information. Additionally, a literature review wasconducted using major databases such as PubMed, Cochrane and Google Scholar to provide context and comparison with previously published findings.

Contrary to the prevailing consensus in the literature, which often reports increased disease activity during pregnancy, our findings indicate that in 80% of cases it remained stable, with no significant differences compared to the pre-pregnancy period. When flares did occur, they primarily involved oral aphthosis, aligning with previously reported patterns. Pregnancy outcomes were generally favourable, with an overall live birth rate of 89.58%. Complications were observed in 13 pregnancies (27.08%), mostly in pregnancies that occurred before BD diagnosis (21%). The most common were spontaneous miscarriage and deep vein thrombosis. Other complications, each occurring in one case, included threatened miscarriage, preterm delivery, low birth weight, gestational diabetes, gestational hypertension, and premature rupture of membranes.

Our findings suggest that Behçet's disease does not usually worsen during pregnancy and that favourable pregnancy outcomes are achievable. Nonetheless, the risk of complications, although relatively low, supports the need for preconception counselling and close multidisciplinary monitoring. This study contributes new insights from a specialised referral centre to the limited body of evidence available on this topic.