As part of her work as an obstetric anesthesiologist at Beth Israel Deaconess Medical Center, Erin J. Ciampa sees pregnant patients experiencing preterm labor every day. “It’s always struck me that for these patients, we have nothing to offer them,” she says. There are no existing therapies that will change the outcome of their pregnancy in the majority of cases, she says, “but also no good explanation for most cases why the patient is experiencing preterm labor.”
Now researchers led by Ciampa and Samir M. Parikh at the University of Texas Southwestern Medical Center have linked depletion of nicotinamide adenine dinucleotide (NAD+) in the placenta to the onset of labor. In studies in mice and in human placentas from healthy pregnancies, researchers have found that labor begins as placental NAD+ levels decrease (Science 2026, DOI: 10.1126/science.adz1624).
Parikh says there’s a huge potential impact from investigating the causes of preterm labor. “Normal gestational length is so critical for the long-term health of the baby.”
The team zeroed in on NAD+ after doing a global metabolomic study looking at placentas from healthy mouse pregnancies. They found that a decrease in levels of the coenzyme coordinated the onset of labor. What’s more, supplements containing NAD+ precursors were able to rescue premature births in mice.
NAD+ is vital to many biochemical processes in the body. One role is as a cofactor for the enzyme 15-hydroxy prostaglandin dehydrogenase, which oxidizes certain prostaglandins to their biologically inactive keto forms. “When NAD+ is abundant, it’s acting as a brake on labor by helping this enzyme inactivate those prostaglandins, which would otherwise promote labor onset,” Ciampa explains.
Ciampa says the ultimate goal of the research is to see if the pathway can be used therapeutically to halt preterm labor or diagnostically to predict which patients are at risk for preterm labor. But, she says, there are many questions left to answer. “Are NAD+-boosting supplements safe? Are they effective at modulating NAD+ levels in the placenta? And does that have positive impacts on a pregnancy?” she asks. The team would also like to find out what’s causing the NAD+ depletion in the placenta at the end of pregnancy.
