High-risk pregnancy

Use of oral NMP-SR has been evaluated across a range of high-risk pregnancies, including but not limited to patients with a poor obstetric history, history of preterm birth, threatened miscarriage or habitual abortion (Table 4 ). A retrospective, multicentre, case-cohort analysis included 185 consecutive women with a high-risk pregnancy who received oral NMP-SR supplementation.38 The most common indications were a history of first (n = 36, 19.5%) or second (n = 37, 20.0%) trimester loss, short/incompetent cervix (n = 22, 11.9%), primary (n = 22, 11.9%) or secondary (n = 12, 5.9%) prophylaxis for preterm birth, and threatened miscarriage with/without spotting (n = 19, 10.3%). Fifty women had a history of ≥ 2 pregnancy losses (28 unexplained recurrent pregnancy loss and 22 spontaneous loss). Oral NMP-SR was generally administered at a dose of 300 mg in women with previous pregnancy loss, cervical risk factors, or threatened miscarriage, and at a dose of 200–300 mg in women with a history of preterm birth or those who had premature contractions. Treatment was usually initiated between 16 and 26 weeks of pregnancy and continued until 34 weeks. Mean treatment duration was 19 ± 1 weeks in patients with cervical risk factors, 18 ± 5 weeks in cases of unexplained recurrent pregnancy loss, and 10 ± 1 weeks in those with threatened miscarriage. In all treated cases, pregnancy continued until 34 weeks, with no adverse outcomes.