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However, the NAC monotherapy arm (600 mg three times daily) showed a trend toward slower decline in forced vital capacity (FVC) that did not reach statistical significance compared to placebo (Martinez et al., N Engl J Med, 2014) [45]
This indicates that downregulation of CBS can alter antioxidant levels, trigger apoptotic cascades, and enhance drug sensitivity
In its response [15], the ACOG concluded that available studies show no clear evidence that proves a direct relationship between the prudent use of APAP during any trimester and fetal developmental issues. The ACOG further concluded that physicians should not change clinical practice until definitive prospective research is done. Considering the ACOG response, it is important to note that evidence of APAP inducing neurodevelopmental problems during the prenatal period is concerning but limited [2,16,17]
