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Testing b12 levels before starting semaglutide provides a baseline

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Therefore, parenteral cyanocobalamin should be administered to a pregnant woman if the benefits outweigh the risks.[15][16] Cyanocobalamin is excreted in the breast milk of nursing women in levels similar to the level of vitamin B12 in maternal plasma.[25] The distributed cyanocobalamin in breast milk has been found to be compatible with breastfeeding by the American Academy of Pediatrics.[26] In addition, there has not been any reports of adverse effects associated with the intake of normal daily requirements of vitamin B12 during lactation

Patients considering combination approaches should understand that this represents an unproven strategy that increases cost and injection burden without documented benefit