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however, because only about 620% of B 12 in the blood is active holoTC, even people with total B 12 levels in the normal range may have a functional B 12 deficiency

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In addition it has been associated with adverse foetal and neonatal outcomes including neural tube defects (NTDs) [32] [33] [34] The mother's B 12 status can be important in determining the later health of the child, as shown in the Pune maternal Nutrition Study, conducted in India

Groups at higher risk of deficiency include older adults (due to reduced stomach acid production), people following vegan or strict vegetarian diets (as B12 is naturally found almost exclusively in animal products), individuals with pernicious anaemia or other malabsorption conditions, those taking certain medications such as metformin or proton pump inhibitors long-term, and people with significant nitrous oxide exposure (including recreational use), which can inactivate B12 in the body