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However, infants of vitamin B 12 -deficient breastfeeding mothers are vulnerable to B 12 deficiency from an early age.19 Maternal vitamin B 12 deficiency has been associated with increased risk of common pregnancy complications, including spontaneous abortion, low birth weight, intrauterine growth restriction and neural tube defects.2022 Children born to vitamin B 12 -deficient women are at increased risk for adverse health outcomes, including developmental abnormalities and anaemia.9 23 In a recent RCT in Bangalore, India, daily maternal vitamin B 12 supplementation (50 g/day) during pregnancy through 6 weeks postpartum substantially improved maternal vitamin B 12 status and increased breast milk and infant plasma vitamin B 12 concentrations.24 In this study, the proportion of children being born small for gestational age was lower in the vitamin B 12 group than in the placebo group (25% vs 34%)

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The combination of reduced caloric intake (from tirzepatide appetite suppression) and enhanced fat breakdown (from AOD 9604 lipolysis) creates a steeper downward trajectory