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In states of obesity and metabolic dysfunction, NNMT is often overexpressed in adipose tissue, depleting nicotinamide and reducing NAD+ availability

Colchicine, Neomycin, Aminosalicylic Acid, H2-blockers (e.g., Ranitidine), and Proton Pump Inhibitors (PPIs, e.g., Omeprazole): These oral medications can all interfere with the intestinal absorption of dietary B12, making the need for injectable B12 more pronounced

This retention advantage may explain why some patients feel more prolonged effects from methylcobalamin even if blood levels look similar

Measure whether daily maternal administration of vitamin B 12 from early pregnancy until 6 months postpartum improves development as measured by the Ages and Stages Questionnaire, Third Edition (ASQ-3), at 6 and 12 months of age