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Smoking is a potential risk factor for regular use of high-dose vitamin B12 supplements as hepatic tumorigenesis may be promoted

[7] The effects of high-dose NAD+ on a developing fetus or nursing infant have not been studied, so the therapy is avoided entirely in these situations out of caution

Note: Oral use only

doi:10.1016/j.rbmo.2009.06.005

But if the body has genetic mutations then these conversions dont happen well at all and the effect is the body does not get the absorption or use of the nutrient

No statistically significant increases in chromosomal aberrations were observed in CHO cells at any tested concentration