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Females can also be affected: those who carry two copies of the defective gene are typically deficient, and even female carriers (heterozygotes) may experience variable symptoms due to X-inactivation (lyonisation), which can result in a mixed population of red blood cells with unpredictable enzyme activity

The absence of maternal pineal melatonin rhythm during pregnancy and lactation impairs offspring physical growth, neurodevelopment, and behavior

Pregnant or nursing women should avoid use due to lack of safety data

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Extreme fatigue and confusion as liver function declines