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For women with vitamin B12 below 358.7 pg/mL, we infer supplementation could improve pregnancy outcomes by restoring homocysteine homeostasis and enhancing oocyte quality, consistent with randomized trials showing that combined B12 and folate supplementation reduces oxidative stress and supports embryo development [7, 8]

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Journal of Nutritional Biochemistry, 24(3), 207213

In more severe cases, you might develop megaloblastic anemia, a condition where your red blood cells become abnormally large and can't carry oxygen effectively