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In the second stage, these factors enter the maternal blood circulation and promote systemic inflammatory responses and endothelial dysfunction, resulting in a series of clinical manifestations

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Some patients may struggle to absorb enough B12 from diet or oral supplements, especially those with conditions like pernicious anemia, gastrointestinal disorders, or those who have undergone certain surgeries

Potential for stronger effect: Because the bioavailability (the fraction of the administered dose that reaches circulation) can be higher via injection, the impact on sleep architecture (e.g., slow-wave sleep increases) may be more pronounced

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