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In certain regions of the world, marginal or subclinical vitamin B 12 deficiency may be fairly common in other age groups as well, including children, premenopausal women, and pregnant women, primarily due to low intake of animal-source foods (reviewed in 5)

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Poor Sterile Technique: Not wiping the stoppers, reusing syringes, or working in a messy environment

Some researchers find this approach reduces waste, though it requires more careful handling and is not universally recommended