ACTA1 and nemaline myopathy: Notably, while the p.Q139H variant has been predominantly linked to severe congenital NM with intranuclear rods,[9] Our patient’s markedly milder, adult-onset phenotype, which manifested following the physiological stresses of pregnancy (e.g., fluid retention, weight gain, and hormonal changes), demonstrates how such stressors can interact with a genetic predisposition to unmask subclinical disease, underscoring the considerable phenotypic heterogeneity of ACTA1-related myopathies.