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Cobb, an OB-GYN in Little Rock, Arkansas

I had my second dose this weekend and last night I had difficulty sleeping due to stomach/chest discomfort Also having menstrual changes since first shot

Prostaglandin F2 exerts its effects via the synthesis of endothelin-1, which inhibits steroidogenesis and stimulates the release of a growth factor, tumor necrosis factor alpha (TNF), which induces cell apoptosis (62)

Neuropathy is believed to result from pyridoxine neurotoxicity to dorsal root ganglia when plasma levels are excessively high

Managing a vitamin B12 deficiency during pregnancy may involve dietary changes, supplementation and, in some cases, B12 injections

Importantly, food intake did not change, confirming that the mechanism was direct fat mobilization rather than appetite suppression (Heffernan et al., 2001)