Vitamin B12
The content of the article

Chemical formula:

C63H88CoN14O14P

a brief description of

Vitamin B12 is very important for the health of the brain, nervous system, DNA synthesis and blood cell formation. Essentially, it is food for the brain. Its use is key at any age, but especially with aging of the body – vitamin B12 deficiency is associated with cognitive impairment. Even mild deficiencies can lead to decreased mental performance and chronic fatigue. One of the most important vitamins for vegetarians, as most of it is found in animal foods.

Also known as: cobalamin, cyanocobalamin, hydroxocobalamin, methylcobalamil, cobamamide, Castle’s external factor.

History of discovery

In the 1850s, an English physician described the lethal form, attributing it to an abnormal gastric mucosa and a lack of stomach acid. The patients presented with symptoms of anemia, tongue inflammation, skin numbness, and abnormal gait. There was no cure for this disease, and it was invariably fatal. The patients were malnourished, hospitalized and had no hope of treatment.

George Richard Minot, M.D. at Harvard, had the idea that substances in food could help patients. In 1923, Minot teamed up with William Perry Murphy, basing his research on previous work by George Whipple. In this study, dogs were brought to a state of anemia, and then tried to determine which foods restore red blood cells. Vegetables, red meat, and especially the liver were effective.

In 1926, at a convention in Atlantic City, Minot and Murphy reported a sensational discovery – 45 patients with pernicious anemia were cured by taking large quantities of raw liver. Clinical improvement was evident and usually occurred within 2 weeks. For this, Minot, Murphy and Whipple received the Nobel Prize in Medicine in 1934. Three years later, William Castle, also a Harvard scientist, discovered that the disease was due to a factor in the stomach. People with a stomach removed often died of pernicious anemia, and eating the liver did not help. This factor, which is present in the gastric mucosa, was called “intrinsic” and was necessary for the normal absorption of the “extrinsic factor” from food. The “intrinsic factor” was absent in patients with pernicious anemia. In 1948, the “extrinsic factor” was isolated in crystalline form from the liver and published by Karl Folkers and his collaborators. It was named vitamin B12.

In 1956, British chemist Dorothy Hodgkin described the structure of the vitamin B12 molecule, for which she received the Nobel Prize in Chemistry in 1964. In 1971, organic chemist Robert Woodward announced the successful synthesis of the vitamin after ten years of trying.

The fatal disease could now be easily cured with injections of pure vitamin B12 and without side effects. The patients recovered completely.

Vitamin B12 rich foods

Indicated is the approximate availability (μg / 100 g) of the vitamin:

Shellfish11.28
Swiss cheese3.06
Feta1.69
Yogurt0.37

Daily requirement for vitamin B12

The intake of vitamin B12 is determined by the nutrition committees in each country and ranges from 1 to 3 micrograms per day. For example, the norm set by the US Food and Nutrition Board in 1998 is as follows:

AgeMen: mg / day (International Units / day)Women: mg / day (International Units / day)
Infants 0-6 months0.4 μg0.4 μg
Infants 7-12 months0.5 μg0.5 μg
Children 1-3 years old0.9 μg0.9 μg
4-8 years old1.2 μg1.2 μg
9-13 years old1.8 μg1.8 μg
Teens 14-18 years2.4 μg2.4 μg
Adults 19 and over2.4 μg2.4 μg
Pregnant (any age)2.6 μg
Breastfeeding mothers (any age)2.8 μg

In 1993, the European Nutrition Committee established the daily intake of vitamin B12:

AgeMen: mg / day (International Units / day)Women: mg / day (International Units / day)
Children 6-12 months0.5 μg0.5 μg
Children 1-3 years old0.7 μg0.7 μg
4-6 years old0.9 μg0.9 μg
7-10 years old1.0 μg1.0 μg
Teens 11-14 years1.3 μg1.3 μg
Teenagers 15-17 years old and older1.4 μg1.4 μg
Pregnant (any age)1.6 μg
Breastfeeding mothers (any age)1.9 μg

Comparative table of the recommended amount of vitamin B12 per day, according to data in different countries and organizations:

AgeMen: mg / day (International Units / day)
European Union (including Greece)1,4 mcg / day
Belgium1,4 mcg / day
France2,4 mcg / day
Germany, Austria, Switzerland3,0 mcg / day
Ireland1,4 mcg / day
Italy2 mcg / day
Netherlands2,8 mcg / day
Nordic countries2,0 mcg / day
Portugal3,0 mcg / day
Spain2,0 mcg / day
United Kingdom1,5 mcg / day
USA2,4 mcg / day
World Health Organization, Food and Agriculture Organization of the United Nations2,4 mcg / day

The need for vitamin B12 increases in such cases:

  • in older people, the secretion of hydrochloric acid in the stomach often decreases (which leads to a decrease in the absorption of vitamin B12), and the number of bacteria in the intestine also increases, which may decrease the level of the vitamin available to the body;
  • with atrophic, the body’s ability to absorb natural vitamin B12 from food decreases;
  • with malignant (pernicious) anemia, there is no substance in the body that helps to absorb B12 from the alimentary tract;
  • during gastrointestinal operations (for example, truncation of the stomach or its removal), the body loses cells that secrete hydrochloric acid and contain an intrinsic factor that promotes the assimilation of B12;
  • in people on a diet that does not contain animal foods; as well as in infants whose nursing mothers are vegetarian or vegan.

In all of the above cases, the body may be deficient in vitamin B12, which can lead to very serious consequences. For the prevention and treatment of such conditions, the attending physicians prescribe the intake of synthetic vitamin orally or in the form of injections.

Physical and chemical properties of vitamin B12

In fact, vitamin B12 is a whole group of substances containing. It includes cyanocobalamin, hydroxocobalamin, methylcobalamin, and cobamamide. It is cyanocobalamin that is most active in the human body. This vitamin is considered the most complex in its structure in comparison with other vitamins.

 

Cyanocobalamin is dark red in color and occurs in the form of crystals or powder. Odorless or colorless. It dissolves in water, is resistant to air, but is destroyed by ultraviolet rays. Vitamin B12 is very stable at high temperatures (the melting point of cyanocobalamin is from 300 ° C), but loses its activity in a very acidic environment. Also soluble in ethanol and methanol. Since vitamin B12 is water-soluble, the body constantly needs to get enough of it. Unlike fat-soluble vitamins, which are stored in adipose tissue and are gradually used by our bodies, water-soluble vitamins are removed from the body as soon as a dose in excess of the daily requirement has been received.

Scheme of getting B12 into the blood:

Vitamin B12 is involved in the formation of genes, protects the nerves, etc. However, for this water-soluble vitamin to function properly, it must be adequately consumed and absorbed. Various factors contribute to this.

In food, vitamin B12 is combined with a certain protein, which, under the influence of gastric juice and pepsin, dissolves in the human stomach. When B12 is released, a binding protein attaches to it and protects it while it is transported to the small intestine. Once the vitamin is in the intestines, a substance called intrinsic factor B12 separates the vitamin from the protein. This allows vitamin B12 to enter the bloodstream and perform its function. For B12 to be properly absorbed by the body, the stomach, small intestine, and pancreas must be healthy. In addition, a sufficient amount of intrinsic factor must be produced in the gastrointestinal tract. Drinking a lot of alcohol can also affect the absorption of vitamin B12, as the production of stomach acid decreases.

 

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Useful properties and its effect on the body

Interaction with other elements

While numerous diseases and medications can negatively affect the effectiveness of vitamin B12, certain nutrients, on the other hand, can support its effect or even make it possible in general:

  • folic acid: This substance is a direct “partner” of vitamin B12. It is responsible for converting folic acid back to its biologically active form after various reactions – in other words, it reactivates it. Without vitamin B12, the body quickly suffers from a functional deficiency of folic acid, since it remains in our body in an unsuitable form for it. On the other hand, vitamin B12 also requires folic acid: in one of the reactions, folic acid (more specifically methyltetrahydrofolate) releases a methyl group for vitamin B12. Methylcobalamin is then converted into a methyl group to homocysteine, with the result that it is converted to methionine.
  • biotin: The second biologically active form of vitamin B12, adenosylcobalamin, requires biotin (also known as vitamin B7 or vitamin H) and magnesium in order to fulfill its important function in the mitochondria. In the case of biotin deficiency, a situation may arise where there is a sufficient amount of adenosylcobalamin, but it is useless, since its reaction partners cannot be formed. In these cases, symptoms of vitamin B12 deficiency may occur, although the level of B12 in the blood remains normal. On the other hand, a urinalysis shows a vitamin B12 deficiency, when in fact it is not. Supplementing with vitamin B12 would also not lead to the cessation of the corresponding symptoms, as vitamin B12 simply remains ineffective due to biotin deficiency. Biotin is very sensitive to free radicals, so additional biotin becomes necessary in cases of stress, heavy sports and illness.
  • calcium: The absorption of vitamin B12 in the intestine with the help of an intrinsic factor is directly dependent on calcium. In cases of calcium deficiency, this absorption method becomes extremely limited, which can lead to a slight vitamin B12 deficiency. An example of this is taking metaphenin, a diabetes medication that lowers intestinal calcium levels to the point that many patients develop B12 deficiency. However, studies have shown that this can be offset by the simultaneous administration of vitamin B12 and calcium. As a result of unhealthy diets, many people suffer from acidity. This means that most of the calcium consumed is used to neutralize the acid. Thus, excessive acidity in the intestines can lead to B12 absorption problems. A lack of vitamin D can also lead to calcium deficiency. In this case, it is advised to take vitamin B12 with calcium in order to optimize the rate of absorption of intrinsic factor.
  • vitamins B2 and B3: they promote the conversion of vitamin B12 after it has been converted to its bioactive coenzyme form.

Absorption of vitamin B12 with other foods

Foods high in vitamin B12 are good for eating with. Piperine, a substance found in peppers, helps the body absorb B12. As a rule, we are talking about meat and fish dishes.

 

Research shows that consuming the right ratio of folate to B12 can improve health, strengthen the heart, and reduce the risk of developing. however, too much acid can interfere with absorption of B12 and vice versa. Thus, maintaining an optimal amount of each of them is the only way to prevent deficits from occurring. Folate is rich in folate, and B12 is found primarily in animal foods such as fish, organic and lean meats, dairy foods, and eggs. Try to combine them!

Natural B12 or Nutritional Supplements?

Like any vitamin, B12 is best obtained from natural sources. There is research that suggests that synthetic dietary supplements can be harmful to the body. In addition, only a physician can determine the exact amount of a substance required for health and well-being. However, in some cases, synthetic vitamins are indispensable.

Vitamin B12 is usually present in dietary supplements as cyanocobalamin, a form that the body readily converts to the active forms of methylcobalamin and 5-deoxyadenosylcobalamin. Diet supplements may also contain methylcobalamin and other forms of vitamin B12. The existing evidence does not show any difference between the forms with respect to absorption or bioavailability. However, the body’s ability to absorb vitamin B12 from dietary supplements is largely limited by intrinsic factor capacity. For example, only about 10 mcg out of a 500 mcg oral supplement is actually absorbed by healthy people.

Vitamin B12 supplementation is especially important for vegetarians and vegans. B12 deficiency among vegetarians depends mainly on the type of diet they follow. Vegans are at greatest risk. Certain B12-fortified cereal foods are a good source of the vitamin and often contain more than 3 mcg of B12 for every 100 grams. In addition, some brands of nutritional yeast and cereals are fortified with vitamin B12. A variety of soy foods, including soy milk and meat substitutes, also contain synthetic B12. It is important to look at the composition of the product, as not all of them are fortified with B12 and the amount of the vitamin can vary.

Various formulas for babies, including those based on, are fortified with vitamin B12. Formulated newborns have higher vitamin B12 levels than breastfed babies. While exclusive breastfeeding is recommended for the first 6 months of a baby’s life, adding a fortified vitamin B12 formula in the second half of infancy can be quite beneficial.

Here are some tips for those who are vegetarian and vegan:

  • Make sure you have a reliable source of vitamin B12 in your diet, such as fortified foods or dietary supplements. It is generally not enough to consume only eggs and dairy foods.
  • Ask your health care provider to check your B12 level once a year.
  • Make sure your vitamin B12 levels are normal before and during pregnancy and if you are breastfeeding.
  • Older vegetarians, especially vegans, may need higher doses of B12 due to age-related issues.
  • Higher doses are likely to be needed by people who are already deficient. According to the professional literature, doses from 12 mcg per day (for children) to 100 mcg per day (for adults) are used to treat people with a lack of vitamin B2000.

The following table contains a list of foods that can be included in a vegetarian and vegan diet that are great for maintaining normal B12 levels in the body:

ProductVegetarianismVeganismComments
CheeseYesNoAn excellent source of vitamin B12, but some types contain more than others. Swiss cheese, mozzarella, feta are recommended.
EggsYesNoThe largest amount of B12 is found in the yolk. The richest in vitamin B12 are duck and goose eggs.
MilkYesNo
YogurtYesNo
Nutritional Yeast Veggie SpreadsYesYesMost spreads can be used by vegans. However, you need to pay attention to the composition of the product, since not all spreads are fortified with vitamin B12.

Use in official medicine

The health benefits of vitamin B12:

  • Potential Cancer Preventive Effect: Vitamin deficiency leads to problems with folate metabolism. As a result, DNA cannot reproduce properly and gets damaged. Experts believe that damaged DNA can directly contribute to the formation of cancer. Supplementing your diet with vitamin B12 along with folate is being researched as a way to help prevent and even treat certain types of cancer.
  • Promotes Brain Health: Low vitamin B12 levels have been found to increase the risk of Alzheimer’s in older men and women. B12 helps keep homocysteine ​​levels low, which may play a role in Alzheimer’s disease. It is also important for concentration and may help reduce ADHD symptoms and poor memory.
  • May prevent depression: Numerous studies have shown a correlation between depression and vitamin B12 deficiency. This vitamin is essential for the synthesis of a neurotransmitter associated with mood regulation. One study, published in the American Journal of Psychiatry, examined 700 women with disabilities over the age of 65. The researchers found that women with vitamin B12 deficiency were twice as likely to suffer from depression.
  • Prevention of anemia and healthy hematopoiesis: Vitamin B12 is essential for the healthy production of red blood cells that are normal in size and maturity. Immature as well as improperly sized red blood cells can lead to lower blood oxygen levels, general symptoms of weakness and wasting.
  • Maintaining Optimal Energy Levels: As one of the B vitamins, vitamin B12 helps convert proteins, fats and carbohydrates into “fuel” for our body. Without it, people often experience chronic fatigue. Vitamin B12 is also needed to transmit neurotransmitter signals that help muscles contract and maintain energy levels throughout the day.

Vitamin B12 in dosage form can be prescribed in such cases:

  • with hereditary vitamin deficiency (Immerslud-Grasbeck disease). It is prescribed in the form of injections, first for 10 days, and then once a month throughout life. This therapy is effective for people with impaired vitamin absorption;
  • with pernicious anemia. Usually by injection, oral or nasal medication;
  • with a deficiency of vitamin B12;
  • with cyanide poisoning;
  • with a high level of homocysteine ​​in the blood. It is taken in combination with folic acid and vitamin B6;
  • with age-related eye disease called age-related macular degeneration;
  • with skin lesions shingles. In addition to relieving skin symptoms, vitamin B12 may also relieve pain and itching in this disease;
  • with peripheral neuropathy.

In modern medicine, three synthetic forms of vitamin B12 are most common – cyanocobalamin, hydroxocobalamin, cobabmamide. The first is used in the form of intravenous, intramuscular, subcutaneous or intra-lumbar injections, as well as in the form of tablets. Hydroxocobalamin can only be injected under the skin or into the muscles. Cobamamide is given by injections into a vein or muscle, or taken orally. It is the fastest of the three types. In addition, these drugs are available in the form of powders or ready-made solutions. And, without a doubt, vitamin B12 is often found in multivitamin formulations.

The use of vitamin B12 in traditional medicine

Traditional medicine, first of all, advises to take foods rich in vitamin B12 in case of anemia, weakness, feeling of chronic fatigue. Such foods are meat, dairy foods, liver.

There is an opinion that vitamin B12 can have a positive effect with and. Therefore, traditional doctors advise using ointments and creams, which include B12, externally and in the form of treatment courses.

Vitamin B12 in the latest scientific research

  • Scientists from the Norwegian Institute of Science and Technology have determined that vitamin B12 deficiency during pregnancy is associated with an increased risk of premature birth. The study involved 11216 pregnant women from 11 countries. Premature birth and low birth weight account for a third of the nearly 3 million newborn deaths each year. The researchers determined that the results also depended on the country of residence of the mother of the fetus – for example, a high level of B12 was associated with a high birth weight ratio in low and middle income countries, but did not differ in countries with a high level of residence. However, in all cases, vitamin deficiency was associated with the risk of preterm birth.
  • Research from the University of Manchester shows that adding high doses of certain vitamins to conventional treatments – especially vitamins B6, B8 and B12 – can significantly reduce symptoms. Such doses reduced mental symptoms, while low amounts of vitamins were ineffective. In addition, it has been noted that B vitamins are most beneficial in the early stages of the disease.
  • Norwegian scientists have found that low levels of vitamin B12 in infants are associated with a subsequent decline in children’s cognitive abilities. The study was conducted among Nepalese children as vitamin B12 deficiency is very common in South Asian countries. Vitamin levels were first measured in newborns (aged 2 to 12 months) and then in the same children 5 years later. Children with lower B12 levels performed worse on tests such as puzzle solving, letter recognition, and interpretation of other children’s emotions. Vitamin deficiency was most often caused by inadequate consumption of animal foods due to the low standard of living in the country.
  • The first of its kind long-term study by the Ohio State University Cancer Research Center shows that long-term vitamin B6 and B12 supplementation is associated with an increased risk of lung cancer in male smokers. Data was collected from over 77 patients who took 55 micrograms of vitamin B12 every day for 10 years. All participants were in the 50 to 76 age group and were enrolled in the study between 2000 and 2002. As a result of observations, it was found that men who smoke were four times more likely to develop lung cancer than those who did not take B12.
  • Recent research suggests that consuming certain vitamins such as B12, D, coenzyme Q10, niacin, magnesium, riboflavin, or carnitine may have therapeutic benefits for seizures. This neurovascular disease affects 6% of men and 18% of women worldwide and is a very serious condition. Some scientists state that it may be due to a lack of antioxidants or from mitochondrial dysfunction. As a result, these vitamins and trace elements, having properties, can improve the patient’s condition and reduce the symptoms of the disease.

The use of vitamin B12 in cosmetology

It is believed to be vitamin B12. By applying cyanocobalamin topically, you can add beautiful shine and strength to your hair. To do this, it is advised to use pharmacy vitamin B12 in ampoules, adding it to masks – both natural (based on oils and natural foods) and purchased. For example, the following masks will benefit hair:

  • mask, which contains vitamins B2, B6, B12 (from ampoules), and burdock oil (a tablespoon), 1 raw chicken egg. All ingredients are mixed and applied to hair for 5-10 minutes;
  • a mixture of vitamin B12 (1 ampoule) and 2 tablespoons of red pepper. With such a mask, you need to be extremely careful and apply it only to the hair roots. It will strengthen the roots and accelerate hair growth. You need to keep it for no longer than 15 minutes;
  • mask with vitamin B12 from an ampoule, a teaspoon of castor oil, a teaspoon of liquid honey and 1 raw. This mask can be washed off one hour after application;

The positive effect of vitamin B12 is observed when it is applied to the skin. It is believed to help smooth out the first wrinkles, tone the skin, renew its cells and protect it from the harmful effects of the external environment. Cosmetologists advise using pharmacy vitamin B12 from an ampoule, mixing it with a fatty base – be it oil or petroleum jelly. An effective rejuvenating mask is a mask made of liquid honey, sour cream, chicken eggs, lemon essential oil, with the addition of vitamins B12 and B12 and aloe vera juice. This mask is applied to the face for 15 minutes, 3-4 times a week. In general, vitamin B12 for the skin works well with cosmetic oils and vitamin A. However, before applying any cosmetic substance, it is worth testing for the presence of allergies or unwanted skin reactions.

The use of vitamin B12 in animal husbandry

As in humans, in some animals, an internal factor is produced in the body, which is necessary for the absorption of the vitamin. These animals include monkeys, pigs, rats, cows, ferrets, rabbits, hamsters, foxes, lions, tigers, and leopards. Intrinsic factor was not found in guinea pigs, horses, sheep, birds and some other species. It is known that in dogs only a small amount of the factor is produced in the stomach – most of it is found in the pancreas. Factors affecting the assimilation of vitamin B12 in animals are a deficiency of protein, iron, vitamin B6, removal of the thyroid gland, and increased acidity. The vitamin is stored mainly in the liver, as well as in the kidneys, heart, brain and spleen. As in humans, the vitamin is excreted in the urine, while in ruminants it is excreted mainly in excrement.

Dogs rarely show signs of vitamin B12 deficiency, however, they need it for normal growth and development. The best sources of B12 are liver, kidney, milk, eggs, and fish. In addition, most ready-to-eat foods are already enriched with essential vitamins and minerals, including B12.

Cats need about 20 mcg of vitamin B12 per kilogram of body weight to maintain normal growth, pregnancy, lactation, and hemoglobin levels. Studies show that kittens may not receive vitamin B12 for 3-4 months without noticeable consequences, after which their growth and development slows down significantly until they stop completely.

The main source of vitamin B12 for ruminants, pigs and poultry is cobalt, which is present in soil and feed. Vitamin deficiency manifests itself in growth retardation, poor appetite, weakness, and nervous diseases.

The use of vitamin B12 in crop production

For many years, scientists have been trying to find a way to get vitamin B12 from plants, as its main natural source is animal foods. Some plants are able to absorb the vitamin through the roots and thus be enriched with it. For example, barley grains or grains contained significant amounts of vitamin B12 after fertilization was added to the soil. Thus, through such research, opportunities are expanding for people who cannot get enough vitamin from its natural sources.

Vitamin B12 myths

  • Bacteria in the mouth or gastrointestinal tract independently synthesize a sufficient amount of vitamin B12. If this were true, vitamin deficiencies would not be that common. You can get a vitamin only from animal foods, artificially fortified foods or food additives.
  • Adequate vitamin B12 can be obtained from fermented soy foods, probiotics, or algae (such as spirulina)… In fact, these foods do not contain vitamin B12, and its content in algae is highly controversial. Even present in spirulina, it is not the active form of vitamin B12 required by the human body.
  • It takes 12 to 10 years for vitamin B20 deficiency to develop. In reality, a deficiency can develop quite quickly, especially when there is an abrupt change in diet, for example, when switching to a vegetarian or vegan diet.

Contraindications and cautions

Signs of a vitamin B12 deficiency

Clinical cases of vitamin B12 deficiency are extremely rare, and in most cases they are caused by serious metabolic disorders, illness, or a complete rejection of foods containing the vitamin. Only a doctor can determine whether there is a lack of a substance in your body by conducting special studies. However, as serum B12 levels approach the minimum, some symptoms and discomfort may occur. The most difficult thing in this situation is to determine whether your body really lacks vitamin B12, since its deficiency can be disguised as many other diseases. Symptoms of a vitamin B12 deficiency can include:

  • irritability, suspicion, personality change, aggression;
  • apathy, drowsiness, depression;
  • , decrease in intellectual abilities, memory impairment;
  • in children – developmental delay, manifestations of autism;
  • unusual sensations in the limbs, loss of sense of body position;
  • weakness;
  • changes in vision, damage to the optic nerve;
  • incontinence;
  • problems of the cardiovascular system (ischemic attacks,,);
  • deep veins;
  • chronic fatigue, frequent colds, loss of appetite.

As you can see, vitamin B12 deficiency can be “disguised” under many diseases, and all because it plays a very important role in the functioning of the brain, nervous system, immunity, circulatory system and DNA formation. That is why it is necessary to check the level of B12 in the body under medical supervision and consult with a specialist about the appropriate types of treatment.

Vitamin B12 is believed to have a very low potential for toxicity, therefore, the borderline level of intake and signs of vitamin excess have not been established by medicine. It is believed that excess vitamin B12 is excreted from the body on its own.

Drug interactions

Certain medicines can affect the level of vitamin B12 in the body. These drugs are:

  • chloramphenicol (chloromycetin), a bacteriostatic antibiotic that affects vitamin B12 levels in some patients;
  • drugs used to treat stomach and reflux, they can interfere with the absorption of B12, slowing down the release of stomach acid;
  • metformin, which is used for treatment.

If you are taking these or any other medications on a regular basis, you should consult with your doctor about their effect on the levels of vitamins and minerals in your body.

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  15. Tormod Rogne, Myrte J. Tielemans, Mary Foong-Fong Chong, Chittaranjan S. Yajnik and others. Associations of Maternal Vitamin B12 Concentration in Pregnancy With the Risks of Preterm Birth and Low Birth Weight: A Systematic Review and Meta-Analysis of Individual Participant Data. American Journal of Epidemiology, Volume 185, Issue 3 (2017), Pages 212–223. doi.org/10.1093/aje/kww212
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  17. Ingrid Kvestad and others. Vitamin B-12 status in infancy is positively associated with development and cognitive functioning 5 y later in Nepalese children. The American Journal of Clinical Nutrition, Volume 105, Issue 5, Pages 1122–1131, (2017). doi.org/10.3945/ajcn.116.144931
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