After battling three years of myositis, a rare autoimmune muscle condition, actor Samantha Ruth Prabhu confirmed she is pregnant with her first child with filmmaker-husband Raj Nidimoru and that she plans to take a brief maternity leave. In fact, she is gearing up to navigating an autoimmune disease during pregnancy, which requires close monitoring to manage symptoms and immunosuppressants safely.
While myositis can increase the risk of muscle inflammation and fatigue, many women with autoimmune conditions can have healthy, successful pregnancies when working closely with rheumatologists and obstetricians. “For a successful pregnancy, women with autoimmune disorders should plan well and consult both their treating specialist and obstetrician before conception so that the disease is well controlled and medications are optimised. With proper care and a team-based approach, many women with autoimmune disorders can go on to have healthy pregnancies and healthy babies,” says Dr Neelam Suri, senior consultant, Obstetrics & Gynaecology, Indraprastha Apollo Hospital, Delhi.
Why autoimmune diseases require special pregnancy planning
Autoimmune disorders occur when the body’s immune system mistakenly attacks its own tissues. In myositis and related conditions such as polymyositis, the immune system targets muscles, leading to inflammation, pain, fatigue and progressive muscle weakness, all of which could make pregnancy arduous.
But this is no longer considered unusual or prohibitively risky. Advances in maternal-foetal medicine, rheumatology and immunology have significantly improved outcomes. However, I would say timing is critical. The best outcomes are seen when conception occurs during a period of disease remission or low disease activity.
Research has consistently shown that active autoimmune disease at conception is associated with higher risks of miscarriage, preterm birth, foetal growth restriction and maternal complications. This is why specialists increasingly recommend pre-pregnancy counselling, medication review and disease stabilisation before attempting conception.
How does one tackle the double burden of pregnancy and muscle disease?
Pregnancy itself places enormous demands on the body. Blood volume increases by nearly 50 per cent, weight gain shifts posture and balance, and energy requirements rise substantially.
For women with inflammatory muscle diseases, physiological changes can amplify existing symptoms. Fatigue, one of the most common complaints in autoimmune disorders, often becomes more pronounced. Routine activities such as climbing stairs, prolonged standing, carrying groceries or even household chores may become increasingly difficult. If respiratory muscles are involved, breathlessness may worsen during pregnancy because the growing uterus already limits lung expansion in later months.
The challenge is not merely physical. Chronic autoimmune conditions often fluctuate unpredictably, making it difficult to distinguish between normal pregnancy-related tiredness and a disease flare.
Can pregnancy worsen autoimmune disorders?
Pregnancy does not automatically worsen autoimmune diseases. Hormonal and immune-system changes during pregnancy can suppress certain inflammatory pathways, leading some women to experience symptom improvement. Others may remain stable throughout pregnancy.
However, some women may experience disease flares either during pregnancy or in the postpartum period, when the immune system undergoes another significant shift. Studies suggest that women whose disease is inactive before conception generally have better pregnancy outcomes than those entering pregnancy with active inflammation. Consequently, regular monitoring through blood tests, muscle strength assessments and foetal growth scans becomes essential.
What are risks to mother and baby?
Although most women with well-controlled autoimmune disorders deliver healthy babies, they remain at higher risk for certain complications. These include pregnancy-induced hypertension, preeclampsia, preterm labour and babies with lower birth weight. Some autoimmune antibodies may also affect placental function, reducing nutrient and oxygen delivery to the foetus.
Women with high disease activity or elevated antibody levels may face a greater risk of miscarriage, particularly during early pregnancy. In rare cases, severe maternal disease can compromise foetal growth and necessitate early delivery. This is why rheumatologists and obstetricians increasingly work as a multidisciplinary team.
What about medication?
One of the most delicate aspects of managing autoimmune disease during pregnancy is medication. Many women require immunosuppressive drugs to keep inflammation under control. While some medications have been extensively studied and are considered relatively safe during pregnancy, others can pose risks to foetal development and must be stopped well before conception.
The challenge for doctors is balancing two priorities: preventing disease flare-ups in the mother while minimising risks to the baby. Stopping treatment altogether is often not the safest option. Uncontrolled disease activity itself can be harmful for both mother and foetus. The goal is to switch to medications that are safer in pregnancy while maintaining disease control. This requires close monitoring throughout all three trimesters.
What about challenges of labour, delivery and recovery?
For women with significant muscle weakness, labour can present additional challenges. The physical effort required during vaginal delivery depends heavily on abdominal and pelvic muscle strength. Patients with severe myositis may struggle to push effectively, increasing the likelihood of assisted delivery or caesarean section.
However, delivery decisions are made on an individual basis and many women with autoimmune conditions are able to have uncomplicated vaginal births. Hormonal changes after childbirth can trigger disease flares in some autoimmune disorders, making continued follow-up essential.
What was once viewed as a high-risk and uncertain journey is increasingly becoming a manageable one, thanks to better medicines, coordinated specialist care and earlier diagnosis.
Samantha Ruth Prabhu tied the knot with filmmaker Raj Nidimoru in December 2025. 
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