A recent report found mutations in the de novo kynurenine pathway and reduced plasma levels of NAD in patients with congenital malformations. In a mouse model, the mutation not only altered the phenotype of the litters but the combination of a homozygous mutation and a niacin-free diet resulted in miscarriages.
Refers to Shi, H. et al. NAD deficiency, congenital malformations and niacin supplementation. N. Engl. J. Med. 377, 544-552 (2017)