- Recurrent miscarriage linked to elevated NAD Salvage Pathway metabolites across all sample types.
- Plasma 1MNA significantly higher (151 vs 89 nM) in affected women.
- Each 1MNA unit increase raised miscarriage odds by 2% after age adjustment.
- Spot urine effectively detected NAD-related metabolic alterations.
- NAD+, NAM, and NMN elevations appeared independent of vitamin B3 use or time since miscarriage.
- Machine-learning model using 1MNA, 2PY, 4PY, and age achieved AUROC 0.889.
- Findings suggest increased NAD consumption or methylation activity linked to inflammation or metabolic stress.
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