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Carnitine status of pregnant women: effect of carnitine supplementation and correlation between iron status and plasma carnitine concentration



It has been shown that plasma carnitine concentrations markedly decline during gestation in women. The reason for this, however, is unknown. One objective of this study was to investigate the effect of carnitine supplementation on plasma carnitine concentrations in pregnant women. The second objective was to investigate the hypothesis that reduced plasma carnitine concentrations during gestation are caused by a reduced carnitine synthesis because of a diminished iron status.


Healthy pregnant women (n=26) were randomly assigned in two groups receiving either a L-carnitine supplement (500 mg L-carnitine per day as L-carnitine L-tartrate) (n=13) or placebo (n=13) from the 13th week of gestation to term.


In the control group, there was a marked reduction of plasma carnitine concentration from the 12th week of gestation to term. This reduction was prevented by the supplementation of carnitine. In the control group, there was a positive relationship between the parameters of iron status (mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and ferritin) and plasma concentration of carnitine (P<0.05). Moreover, there were inverse correlations between the concentrations of ferritin and the carnitine precursor γ-butyrobetaine in plasma, and between γ-butyrobetaine and carnitine in plasma (P<0.05).


This study confirms that plasma carnitine concentrations decline in the course of pregnancy, an effect that can be prevented by the supplementation of carnitine. Data of this study, moreover, suggest that the decline of plasma carnitine concentration during pregnancy could be caused by a reduced rate of carnitine biosynthesis, possibly because of an inadequate iron status.

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  • Bargen-Lockner C, Hahn P, Wittmann B (1981). Plasma carnitine in pregnancy. Am J Obestet Gynecol 140, 412–414.

    Article  CAS  Google Scholar 

  • Bartholmey SJ, Sherman AR (1985). Carnitine levels in iron-deficient rat pups. J Nutr 115, 138–145.

    Article  CAS  Google Scholar 

  • Bartholmey SJ, Sherman AR (1986). Impaired ketogenesis in iron-deficient rat pups. J Nutr 116, 2180–2189.

    Article  CAS  Google Scholar 

  • Böhles H, Evangeliov A, Bervoets K, Eckert I, Sewell AC (1994). Carnitine esters in metabolic disease. Eur J Pediatr 153, S57–S61.

    Article  Google Scholar 

  • Böhles H, Ullrich K, Endres W, Behbehani AW, Wendel U (1991). Inadequate iron availability as a possible cause of low serum carnitine concentrations in patients with phenylketonuria. Eur J Pediatr 150, 425–428.

    Article  Google Scholar 

  • Cederblad G, Fåhraeus L, Lindgren K (1986). Plasma carnitine and renal-carnitine clearance during pregnancy. Am J Clin Nutr 44, 379–383.

    Article  CAS  Google Scholar 

  • Cederblad G, Niklasson A, Rydgren B, Albertsson-Wikland A, Olegård R (1985). Carnitine in maternal and neonatal plasma. Acta Pediatr Scand 74, 500–504.

    Article  CAS  Google Scholar 

  • Cemeroglu AP, Kocaba° CN, Co°kun T, Gürgey A (2001). Low serum carnitine concentrations in healthy children with iron deficiency anemia. Pediatr Hematol Oncol 18, 491–495.

    Article  CAS  Google Scholar 

  • Cho SW, Park YO, Cha YS (2003). Plasma and urinary concentration in pregnant Korean women. FASEB 17, A733–A734.

    Article  Google Scholar 

  • Citak EC, Citak FE, Kurekci AE (2006). Serum carnitine levels in children with iron- deficiency anemia with or without pica. Pediatr Hematol Oncol 23, 381–385.

    Article  CAS  Google Scholar 

  • Duran M, Loof NE, Ketting D, Dorland L (1990). Secondary carnitine deficiency. J Clin Chem Clin Biochem 28, 359–363.

    CAS  PubMed  Google Scholar 

  • Genger H, Sevelda P, Vytiska-Binstorfer E, Salzer H, Legenstein E, Lohninger A (1988). Carnitine levels in pregnancy. Z Geburtshilfe Perinatol 192, 134–136.

    CAS  PubMed  Google Scholar 

  • Grube M, Schwabedissen HM, Draber K, Präger D, Möritz KU, Linnemann K et al. (2005). Expression, localization, and function of the carnitine transporter octn2 (slc22a5) in human placenta. Drug Metab Dispos 33, 31–37.

    Article  CAS  Google Scholar 

  • Günter HH, Peulecke W, Oehler K, Scharf A, Schumann G, Sohn C (2002). The concentration of carnitine in the last trimester of pregnancy subject to glucose tolerance. Zentralbl Gynakol 124, 533–537.

    Article  Google Scholar 

  • Hahn P (1982). Development of lipid metabolism. Annu Rev Nutr 2, 91–111.

    Article  CAS  Google Scholar 

  • Harvey LJ, Dainty JR, Hollands WJ, Bull VJ, Hoogewerff JA, Foxall RJ et al. (2007). Effect of high-dose iron supplements on fractional zinc absorption and status in pregnant women. Am J Clin Nutr 85, 131–136.

    Article  CAS  Google Scholar 

  • Lain KY, Catalano PM (2007). Metabolic changes in pregnancy. Clin Obstet Gynecol 50, 938–948.

    Article  Google Scholar 

  • Lindstedt G, Lindstedt S (1970). Cofactor requirements of γ-butyrobetaine hydroxylase from rat liver. J Biol Chem 245, 4178–4186.

    CAS  PubMed  Google Scholar 

  • Marzo A, Cardace G, Corbelletta C, Pace S, D'Iddio S, Verrotti C et al. (1994). Plasma concentration, urinary excretion and renal clearance of L-carnitine during pregnancy: a reversible secondary L-carnitine deficiency. Gynecol Endocrinol 8, 115–120.

    Article  CAS  Google Scholar 

  • McGarry JD, Brown NF (1997). The mitochondrial carnitine palmitoyltransferase system. From concept to molecular analysis. Eur J Biochem 244, 1–14.

    Article  CAS  Google Scholar 

  • Milman N (2006). Iron and pregnancy—a delicate balance. Ann Hematol 85, 559–565.

    Article  CAS  Google Scholar 

  • Mitchell ME, Snyder EA (1991). Dietary carnitine effects on carnitine concentrations in urine and milk in lactating women. Am J Clin Nutr 54, 814–820.

    Article  CAS  Google Scholar 

  • Novak M, Monkus EF, Chung D, Buch M (1981). Carnitine in the perinatal metabolism of lipids. I. Relationship between maternal and fetal plasma levels of carnitine and acylcarnitines. Pediatrica 67, 95–100.

    CAS  Google Scholar 

  • Novak M, Penn-Walker D, Hahn P, Monkus EF (1975a). Effect of carnitine on lipolysis in subcutaneous adipose tissue of newborns. Biol Neonate 25, 84–94.

    Google Scholar 

  • Novak M, Penn-Walker D, Monkus EF (1975b). Oxidation of fatty acids by mitochondria obtained from newborn subcutaneous (white) adipose tissue. Biol Neonate 25, 95–107.

    Article  CAS  Google Scholar 

  • Rebouche CJ, Bosch EP, Chenard CA, Schabold KJ, Nelson SE (1989). Utilization of dietary precursors for carnitine synthesis in human adults. J Nutr 119, 1907–1913.

    Article  CAS  Google Scholar 

  • Rebouche CJ, Seim H (1998). Carnitine metabolism and its regulation in microorganisms and mammals. Annu Rev Nutr 18, 39–61.

    Article  CAS  Google Scholar 

  • Ringseis R, Pösel S, Hirche F, Eder K (2007). Treatment with pharmacological peroxisome proliferator-activated receptor alpha agonist clofibrate causes upregulation of organic cation transporter 2 in liver and small intestine of rats. Pharmacol Res 56, 175–183.

    Article  CAS  Google Scholar 

  • Schmidt-Sommerfeld E, Penn D, Sodha RJ, Prögler M, Novak M, Schneider H (1985). Transfer and metabolism of carnitine and carnitine esters in the in vitro perfused human placenta. Pediatr Res 19, 700–706.

    Article  CAS  Google Scholar 

  • Schoderbeck M, Auer B, Legenstein E, Genger H, Sevelda P, Salzer H et al. (1995). Pregnancy-related changes of carnitine and acylcarnitine concentrations of plasma and erythrocytes. J Perinat Med 23, 477–485.

    Article  CAS  Google Scholar 

  • Spiering BA, Kraemer WJ, Vingren JL, Hatfield DL, Fragala MS, Ho JY et al. (2007). Responses of criterion variables to different supplemental doses of L-carnitine L-tartrate. J Strength Cond Res 21, 259–264.

    Article  Google Scholar 

  • Steiber A, Kerner J, Hoppel CL (2004). Carnitine: a nutritional, biosynthetic, and functional perspective. Mol Asp Med 25, 455–473.

    Article  CAS  Google Scholar 

  • Tanzer F, Hizel S, Cetinkaya O, Sekreter E (2001). Serum free carnitine and total triglyceride levels in children with iron deficiency anemia. Int J Vitam Nutr Res 71, 66–69.

    Article  CAS  Google Scholar 

  • Vaz FM, Wanders RJ (2002). Carnitine biosynthesis in mammals. Biochem J 361, 417–429.

    Article  CAS  Google Scholar 

  • Vaz FM, Ofman R, Westinga K, Wanders RJ (2001). Molecular and biochemical characterization of rat ɛ-N-trimethyllysine hydroxylase, the first enzyme of carnitine biosynthesis. J Biol Chem 276, 33512–33517.

    Article  CAS  Google Scholar 

  • Volek JS, Kraemer WJ, Rubin MR, Gómez AL, Ratamess NA, Gaynor P (2002). L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress. Am J Physiol Endocrinol Metab 282, E474–E482.

    Article  CAS  Google Scholar 

  • Warshaw JB, Curry E (1980). Comparison of serum carnitine and ketone body concentrations in breast- and in formula-fed newborn infants. J Pediatr 97, 122–125.

    Article  CAS  Google Scholar 

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This study was in part supported by Lonza (Basel, Switzerland). We thank all the women who took part in the study, the midwives and medical practitioners of the Department of Obstetrics and Gynecology; Ewald Seliger and members of hormone laboratory of the University Hospital. We also thank Frank Hirche for measuring the carnitine compounds with HPLC-MS/MS.

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Correspondence to K Eder.

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Contributors: UK and KE designed the study concept and GS and FR provided significant advice on this concept. CW, GS and CS were responsible for the study coordination, proband care and the sample collection. UK was responsible for the analyses. UK and KE led the writing. All authors read and approved the final version of the manuscript.

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Keller, U., van der Wal, C., Seliger, G. et al. Carnitine status of pregnant women: effect of carnitine supplementation and correlation between iron status and plasma carnitine concentration. Eur J Clin Nutr 63, 1098–1105 (2009).

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