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Folate deficiency during this period is associated with the development of autism spectrum disorders in children, neural tube irregularity, and brain development defects in the fetus and brain function in later life (68, 69)

Mediterr J Hematol Infect Dis

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Two patients were unable to use the drops due to technical reasons and one had sesame oil allergy (the basis of the hydroxocobalamin nasal drops)

For individuals requiring supplementation due to confirmed deficiency or malabsorption, therapeutic doses vary considerably depending on the underlying cause: Dietary deficiency : 50150 micrograms daily orally, or cyanocobalamin tablets as prescribed Pernicious anaemia : Initially hydroxocobalamin 1 mg intramuscularly three times weekly for two weeks, then maintenance injections every two to three months [3] Neurological involvement : More intensive regimens may be required, with hydroxocobalamin injections on alternate days until symptom improvement [3] NICE guidance emphasises that supplementation should be evidence-based rather than speculative