Taking niacin with meals also helps reduce this side effect. Acquired tolerance will also help reduce flushing; after several weeks of a consistent dose, most people no longer experience flushing. Slow- or "sustained"-release forms of niacin have been developed to lessen these side effects. Liver damage
Niacin in medicinal doses can cause modest elevations in serum transaminase and unconjugated bilirubin, both biomarkers of liver injury. The increases usually resolve even when drug intake is continued. However, less commonly, the sustained release form of the drug can lead to serious hepatotoxicity, with onset in days to weeks. Early symptoms of serious liver damage include nausea, vomiting and abdominal pain, followed by jaundice and pruritus. The mechanism is thought to be a direct toxicity of elevated serum niacin. Lowering dose or switching to the immediate release form can resolve symptoms. In rare instances the injury is severe, and progresses to liver failure. Diabetes
The high doses of niacin used to treat hyperlipidemia have been shown to elevate fasting blood glucose in people with type 2 diabetes. Long-term niacin therapy was also associated with an increase in the risk of new-onset type 2 diabetes. Other adverse effects
High doses of niacin can also cause niacin maculopathy, a thickening of the macula and retina, which leads to blurred vision and blindness. This maculopathy is reversible after niacin intake ceases. Niaspan, the slow-release product, has been associated with a reduction in platelet content and a modest increase in prothrombin time.
Meconium in the amniotic fluid
If a fetus has meconium in their lungs when they are born, this prevents the pressure in their lungs from falling, which normally facilitates the transition to independent breathing. Since aspiration of meconium can lead to improper oxygenation due to obstruction and carries the potential risk for inflammatory pneumonitis, this is an important diagnosis to make in the setting of newborn respiratory distress. Gestational Hypertension
If hypertension in the mother occurs after the 20th week and meets certain criteria, this is considered preeclampsia/eclampsia. The mechanism of preeclampsia/eclampsia is unknown, but consequences if left untreated can include fetal growth restriction or death, as well as pose medical risks to the mother. Signs and symptoms of preeclampsia can include swelling, protein in the urine, headaches, vomiting, and abnormal labs that assess kidney and liver function, some of which may be considered severe preeclampsia or eclampsia. Post-term pregnancy
Breathing problems
Anemia
Abnormal position and presentation of the fetus
Multiple births
Shoulder dystocia
Umbilical cord prolapse
Nuchal cord
Placental abruption
Premature closure of the fetal ductus arteriosus
Uterine rupture
Intrahepatic cholestasis of pregnancy, a liver disorder during pregnancy
Maternal diabetes (Type 1 or 2) or gestational diabetes (GDM)

Prevention
Monitoring of the mother and fetus prior to birth is critical to avoid complications after birth. This is often done via electronic fetal heart rate (FHR) monitoring, which helps providers monitor the fetus heart rate to ensure it is receiving enough oxygen, monitor the mothers contractions, and monitor the mothers blood pressure and systemic symptoms for gestational hypertension, preeclampsia, or eclampsia.