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Importantly, these effects occurred at rates similar to placebo groups, suggesting that many cases represented background occurrence rather than treatment-specific effects

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[16] Although cyanocobalamin lacks a defined upper-toxicity threshold due to its water solubility and renal elimination, exceptionally high cumulative doses have been temporally associated with acneiform eruptions, altered potassium homeostasis, and theoretical thrombotic risk, emphasizing the importance of evidence-based dosing

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Optimal maternal nutrition during pregnancy is thus imperative for the health of both the woman and the infant