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Vitamin B12 deficiency If left untreated, vitamin B deficiency can harm your brain and nervous system, leading to issues such as: Incontinence (not being able to control your pee or poop) Nerve issues, such as numbness, weakness, or nerve pain Erectile dysfunction (not being able to get an erect penis) Paralysis (not being able to move your body) Memory loss Paranoia (feeling like others are trying to hurt you) If you don’t have symptoms but are at risk of low B12 levels, your doctor might also want you to have regular tests

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OXIDATION – TOXIC PATHWAY (CYP2E1 enzyme) • Only 5-10% of acetaminophen in healthy non-pregnant adults • INCREASES by 80% during pregnancy[⁶⁰] • Creates NAPQI (N-acetyl-p-benzoquinone imine)—the toxic metabolite • NAPQI formation 43% HIGHER in first trimester[⁶⁰] • NAPQI must be immediately neutralized by glutathione • When glutathione is depleted, NAPQI causes cellular damage • Crosses the placenta and damages fetal brain HOW PREGNANCY CHANGES ACETAMINOPHEN METABOLISM METABOLIC PATHWAY CHANGES DURING PREGNANCY[⁶⁰⁻¹⁰⁰⁻¹⁰¹] Human pharmacokinetic studies reveal dramatic shifts in how pregnant women metabolize acetaminophen: Oxidation to NAPQI (Toxic Pathway) INCREASES by 80% The Brookhuis et al