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This is the most serious warning from the FDA

However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional

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A large-cohort study also revealed that lack of maternal folic acid supplementation at peri-conception resulted in increased risk for a DS birth due to errors occurred at maternal meiosis II in the aging oocyte, and it was shown that the methylation status of chromosome 21 peri-centromeric regions could favor recombination errors during meiosis leading to its malsegregation

Review papers which looked at the few available clinical trials have not offered any clear guidelines for the clinician seeking advice on best practice for the management of patients with hyperpigmentation