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REVIEW ARTICLE

A pandemic within a pandemic: Diabetes, gestational diabetes, and vitamin B12 deficiency in pregnant women during the COVID-19 era

Huseyin Karakaya1 ,  Meral Ekim2 ,  Hasan Ekim3 ,  Gokhan Dogukan Akarsu4*
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1 Department of Gynecology and Obstetrics, Faculty of Medicine, Yozgat Bozok University, Yozgat, Türkiye
2 Department of Biochemistry, Faculty of Medicine, Yozgat Bozok University, Yozgat, Türkiye
3 3 Department of Cardiovascular Surgery, Faculty of Medicine, Yozgat Bozok University, Yozgat, Türkiye
4 Department of Pharmacy Services, Vocational School of Health Services, Yozgat Bozok University, Yozgat, Türkiye
JCTR, 026090014 https://doi.org/10.36922/JCTR026090014
Received: 23 February 2026 | Revised: 30 April 2026 | Accepted: 8 May 2026 | Published online: 16 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly worsened health outcomes in pregnant women, a population already vulnerable due to physiological immune suppression and increased insulin resistance. Gestational diabetes mellitus (GDM) and vitamin B12 deficiency further compound these risks, creating a complex and potentially dangerous clinical picture. Aim: This review examines the interrelationships between COVID-19, GDM, and vitamin B12 deficiency in pregnancy, and evaluates the clinical implications for maternal and fetal health. Methods: A narrative review of the current literature was conducted, focusing on the mechanisms linking severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, GDM, vitamin B12 metabolism, metformin use, and nutritional status during pregnancy. Results: SARS-CoV-2 directly damages pancreatic beta cells and triggers hyperinflammation, disrupting glycemic control in pregnant women. Vitamin B12 deficiency elevates homocysteine levels, impairing insulin signaling and promoting thrombosis, thereby increasing risks of GDM, preeclampsia, and adverse fetal neurodevelopmental outcomes. Metformin, widely used in GDM and polycystic ovary syndrome (PCOS) management, further reduces B12 absorption. Pandemic-related disruptions to antenatal care, food access, and psychosocial stress accelerated B12 depletion in this population. The Mediterranean diet offers partial mitigation, though targeted supplementation remains necessary in high-risk individuals. Conclusion: Routine B12 screening should be integrated into standard antenatal care, particularly for women with GDM, PCOS, or long-term metformin use. Relevance for patients: Pregnant women with GDM or PCOS using metformin are at heightened risk of vitamin B12 deficiency, which can silently harm both mother and baby. Regular B12 monitoring and timely supplementation are simple, safe, and potentially life-changing interventions.

Graphical abstract
Keywords
COVID-19
Gestational diabetes
Vitamin B12 deficiency
Pregnancy
Metformin
Mediterranean diet
Homocysteine
SARS-CoV-2
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
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