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[310] A large prospective study reported a 20.3% prevalence of vitamin B12 deciency after 9.5 years of metformin use, [10] and a large dataset provided by the National Health and Nutrition Examination Survey showed a 22% prevalence when vitamin B12 deciency was dened as levels below 300 pg/mL

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[21] B 12 deficiency in pregnant women is increasingly common [22] and has been shown to be associated with major maternal health implications, including increased obesity, [22] higher body mass index (BMI), [23] insulin resistance, [21] gestational diabetes, and type 2 diabetes (T2D) in later life