By Pauline Cottee
In recent days, a study from the Victor Chang Cardiac Research Institute in Sydney, Australia has hit the world headlines with their work showing that the prevention of miscarriage and birth defects can be eliminated by taking a simple nutrient.
The nutrient in question is niacin (nicotinic acid, NAD) or Vitamin B3, one of the eight members of the Vitamin B family. In the body, niacin and its derivative nicotinamide are used as co-enzymes in cell metabolism pathways to produce energy. Simply put, these two nutrients are involved in breaking down the fats, proteins, carbohydrates and alcohol consumed in our diet and converting it into energy the body can use. Its link to miscarriage and congenital birth defects arose from the study released by the Dunwoodie group. And its release has shown an interesting side to the interpretation of scientific findings and marketing of science within the media.
First off, we will acknowledge that the study conducted by Dunwoodie and peers was one that was conducted with the utmost scientific integrity. It is a solid piece of scientific research worthy of its publication. To briefly describe the work, this group examined four families in which one of their offspring was born with a congenital abnormality. Additionally, three of the four families had also experienced the miscarriage of at least one baby. The researchers took a DNA sample from each member of these four families and examined it to see if there were any matches of DNA amongst these people that may contribute to these birth defects. When they did this, they found two matches, both of which are involved in the conversion of Niacin into useable energy. From here, the researchers developed mice which mimicked the complete elimination of these DNA matches and studied what happened to the offspring of these mice. In a series of elegant experiments, these researchers showed that it is a complication within the embryo and not the mother which leads to the inability of NAD as an energy source and it is the absence of this co-factor that contributes to the defective appearance of the embryo and its subsequent death. Further, these researchers demonstrate that live, normal embryos were born when the same strains of pregnant mice were given water supplemented with nicotinic acid.
At this point you may be asking what the big deal is; why or how has this study been misinterpretation in the media. It’s fairly straight forward, if you’ve had a miscarriage or a child with a congenital birth defect you just take niacin right? I guess this is where the areas of good science and the marketing of science in the media get a little murky. The media statement released by the Victor Chang Institute marketed this outcome essentially as one of the biggest breakthroughs in maternal medicine, that niacin supplementation was the cure for congenital defects and miscarriage. Professor Dunwoodie has been quoted accounting this scientific finding as having “the potential to significantly reduce the number of miscarriages and birth defects around the world”. And while that is true, it is only for those who are affected by niacin genetic mismatches and their offspring. The President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANCOG) has also raised the same concern regarding this study, citing that while there was nothing wrong with the science undertaken itself, but rather how the significance of this result has been marketed to/in the media as the cure of miscarriage and birth defects, may be misinforming. It has to be noted that the incidence of niacin deficiency in the human population is not very frequent; niacin is a water soluble nutrient that is readily available in the diet. At the genetic level (as like the four families studied) it’s estimated that 1/20,000 births are affected. A deficiency due to poor nutrition is rarely seen in Western cultures and in modern times generally only seen in people living in developing nations. While this research has huge implications for some families, there will likely be a significant number of others where there will be no benefit at all. And to this end, the Victor Chang Institute released an updated statement signifying that this discovery would not be able to cure all causes of miscarriage and congenital birth defects.
However, the hyped extrapolation of these results in the media had already begun. A blog published by a popular website for ‘hip kids and parents’ wrote “When scientists introduced vitamin B3 to pregnant women the results were outstanding. All babies were born perfectly healthy, whereas beforehand there were embryos that were lost through miscarriage or born with severe birth defects”. Technically, niacin supplementation did cure the problem of birth defects and miscarriage but it’s only been shown in mice and their offspring so far. The researchers at the Victor Chang Institute are only now planning on undertaking human clinical trials based on these outcomes. But given the popularity of this website, and the (current) 3,600 Facebook shares of this blog post, it demonstrates the depth and quickness of how many people have just been misinformed on its application to humans, miscarriage and birth defects. Similar stories were also shown on major news websites across the world with no correction in light of the updated statement from the Victor Chang Institute.
With all this said, where does that then leave women trying to conceive and those who are pregnant; what should they do in light of this study? I would say not a lot. Don’t get me wrong, these results are very important. But it has to be stressed that these conclusions are only going to apply to a very specific group of people. Not all women who suffer from miscarriages or have children with congenital birth defects will fall into this class of specific anomalies with their cell metabolism pathways. Would niacin supplementation be a worthy inclusion to a woman’s preconception vitamin regime? It depends. In preconception multivitamins such as Elevit, the recommended daily intake of niacin (18mg) is already part of the formulation. While other formulations may or may not contain the same or similar levels, niacin is readily available in a Western diet and with a well-balanced diet the recommended levels should be easily obtained throughout the daily intake of food. Given niacin is a water soluble nutrient, taking excess quantities of it will only be flushed from your system – making for very expensive urine!
It cannot be stressed enough that if you have had a child born with congenital defects and experienced miscarriages, that it would be worthwhile speaking to your Fertility specialist or genetic counsellor about how niacin could be underpinning these problems. However, for the whole, the mystery of why embryos fail to develop long term and their defects remain elusive. If you have any questions, or would like links to the articles used for this blog, please do not hesitate to get in contact with us. Best of luck!
