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In response to hyperglycemia, the placenta undergoes extensive metabolic reprogramming, including disturbances in lipid metabolism, reduced efficiency in fatty acid oxidation, altered amino acid transport, and adaptations in glycolysis

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84 While this could be secondary to dietary changes in those with active disease (reduced fruits and vegetable intake for example), univariate analysis demonstrated that penetrating disease (p=0.03), obesity (p=0.02) and need for a biologic (p=0.006) were also associated with vitamin C deficiency in this study

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