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[17] Physiologic B12 requirements increase during gestation, and parenteral cyanocobalamin is considered appropriate when dietary intake or intestinal absorption is inadequate

[2] Choline chloride serves as an essential substrate for phosphatidylcholine and betaine formation, thereby enhancing bile-dependent lipid emulsification and acting as an osmolyte that maintains hepatocyte membrane integrity under oxidative stress

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Although there could be a number of different causes for this issue, for some, the main issue is a B12 deficiency