Vitamin B3 and miscarriage

By , 13 August 2017

Vitamin B3 and miscarriage

This week, media outlets widely reported findings of an Australian study linking vitamin B3 to birth defects and miscarriages.  The study, published in the New England Journal of Medicine, was undertaken by an Australian research team headed by Professor Sally Dunwoodie.  The study findings have even been compared to the discovery of the link between folate and neural tubes defects such as spina bifida.

Unfortunately, though perhaps not surprisingly, media enthusiasm has allowed a good headline to get in the way of responsible journalism.  While the discovery of an association between vitamin B3 and birth defects (in mice) is interesting, important, and creates many questions for further research, it is a far, far cry from "preventing millions of women from suffering miscarriage".  

In a nutshell, the researchers of this study:

  • Tried to identify random genes that might be associated with the occurrence of multiple congenital abnormalities (that is, more than one birth defect occurring in the same person, suggesting something more than just random chance at work).
  • Found a couple of possible genes, among four families that included such individuals.
  • Determined that these genes were associated with NAD metabolism - mutations in these genes meant less NAD produced.
  • Created "knockout" mice (that is, mice that were genetically engineered to make zero NAD by completely removing all function of these genes - as opposed to these families, that had the genes, but some mutation in them that reduced their function).  That is to say, they created mice with significantly warped metabolisms.
  • Determined that these mice had babies with lots of congenital abnormalities (and early abortions – probably related to the lethality of multiple congenital abnormalities).
  • Acknowledged that NAD is synthesised using ether niacin (B3) or tryptophan (found in cheese).
  • Fed the mummy mice niacin and fixed the problem (which they created….)
  • Concluded that:
    • NAD is important to embryogenesis (like many other things….) -- this seems reasonable. 
    • Removing it – entirely – creates problems, in a mouse model at least. -- interesting. 
    • Removing it and replacing it prevents these problems. -- also interesting, perhaps not surprising given the first two points.
    • Theorised that niacin supplementation may be useful in these families with recognised gene mutations affecting NAD pathways-- MAYBE, but remains to be answered.

Importantly (and curiously left out by the media):

  • They didn’t actually conclude (nor should they), that niacin supplementation reduces birth defects in “normal” families.
  • NOWHERE in their study is the word “miscarriage” or phrase “first trimester loss” used (even though the entire media reports focus on B3 reducing miscarriage).
  • There are no trials (“intervention trials”) looking at the effect of NAD/niacin/B3 on low-risk women (or low-risk/non-mutant mice, for that matter).
  • Likewise, there are no intervention trials looking at supplementation in HIGH risk women, such as in these families.
  • There is NO safety data about high-dose niacin supplementation

The assumption is that something occurring naturally can’t be bad, BUT the entire HRT fiasco came from initial studies suggesting all women should take oestrogen because it prevents heart disease, and women with early menopause have more heart disease, so extra oestrogen must be good.  But women with extra oestrogen just turned out to have more strokes, more clots (and… MORE heart disease!) – the painful lesson from the HRT trials is that jumping in early, on the first promise of something useful, is not without risk. 

After much pain, a few law suits, and many more trials, we eventually settled on “HRT benefits may outweigh risks, in some women, sometimesmaybe”.

The unfortunate but inevitable consequence of over-enthusiastic journalism that reports gross extrapolations of animal studies is that women are offered premature - and currently unfounded - hope of a treatment that is not only unproven, but also untested.  With headlines like these, the only winners are manufacturers of Vitamin B3 supplements.  

Nevertheless, let's look forward to the follow-up study findings from this Australian team of researchers!

Vitamin B3 and miscarriage
 

About Dr David Moore

Vitamin B3 and miscarriage

David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland.  He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery.  David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments.  He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.

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