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While the etiology of NTD is multifactorial, some studies have found that blood concentrations of homocysteine or holo-transcobalamin to be lower in NTD-affected infants and mothers compared to non-affected controls (reviewed in 59)

After your weekly subcutaneous injection, the medication reaches its highest concentration in your bloodstream within 13 days, with most patients experiencing peak appetite suppression around 48 hours post-injection

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10.1038/s41467-018-05470-4 Nat

"And so, when you lose weight, and sometimes when you lose weight rapidly, the hormones and the new you aren't in concert