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One cause could be a medical problem, the other insufficient milk production

Pregnancy: There are no data from the use of pemetrexed in pregnant women but pemetrexed, like other antimetabolites, is suspected to cause serious birth defects when administered during pregnancy,so should not be used during pregnancy unless clearly necessary, after a careful consideration of the needs of the mother and the risk for the foetus

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Daily high doses of B12 may not likely cause harm in most people, but extremely high doses should possibly be avoided unless a healthcare professional prescribes it

doi: 10.1111/j.1476-5381.1993.tb13429.x 79

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