Study of Nicotinamide in Early Onset Preeclampsia

Inclusion Criteria

• •Maternal age 18-55 years
• •Singleton pregnancy with no known fetal anomalies
• •Early-onset preeclampsia OR early-onset severe gestational hypertension defined as:
• •* Early-onset: between 24 weeks 0 days and -33 weeks 3 days, based on menstrual dating confirmed by first or second trimester ultrasound OR second trimester ultrasound if menstrual dating unavailable;
• •* Preeclampsia:
• •New onset hypertension and proteinuria, with systolic BP \> 140 mm Hg and/or diastolic BP \> 90 mm Hg on two occasions 6 hours apart and \> 300 mg proteinuria on 24 hour urine collection OR urine P/C ratio \>0.3;
• •New onset hypertension and NO proteinuria, with systolic BP \> 140 mm Hg and/or diastolic BP \> 90 mm Hg on two occasions 6 hours apart and one or more of the following: serum creatinine \>1.1 mg/dL or doubling from baseline ,or central nervous system symptoms or visual changes
• •Severe preeclampsia defined as new onset systolic BP \> 160 mm Hg and/or diastolic BP \> 105 with proteinuria as above or or without proteinuria and one or more of the following criteria listed above
• •* Candidate for expectant management for at least 48 hours
• •* Deemed clinically stable by primary clinician and candidate for expectant management (delayed delivery) for at least 48 hours;
• •Maternal liver function tests \< 2x ULN
• •Maternal platelet count \> 100,000 mm³
• •Planned expectant management
• •Pre-existing medical diseases such as hypertension, diabetes, endocrine disorders, gastrointestinal diseases, are well controlled
• •Fetal well-being established by estimated fetal weight \> 5th %tile; normal amniotic fluid volume (MVP \> 2 cm); normal Umbilical Artery (UA) Dopplers; or reactive Non Stress Test (NST) or Biophysical Profile (BPP) \> 6
• •Delivery not anticipated within 48 hours of enrollment