A national survey of iron and folate status in pregnant women in Switzerland.

Women often do not meet the increased iron and folate needs of pregnancy. Maternal iron-deficiency anemia is associated with poor maternal and infant outcomes, including preterm delivery and low birth weight. Poor folate status increases risk for maternal anemia, spontaneous abortion, and congenital defects. Because of this, supplemental iron and folate are often recommended during pregnancy. There are few data on iron and folate status in pregnant women in Switzerland. We measured iron and folate status in a national sample of Swiss pregnant women, estimated the prevalence of anemia, and determined if supplement use is associated with iron and/or folate status in this group. A 3-stage probability to size cluster sampling method was used to obtain a representative national sample of pregnant women (n = 381) in the second and third trimester. We measured hemoglobin, hematocrit, mean corpuscular volume, and serum folate and ferritin concentrations. Serum transferrin receptor concentration was determined in anemic subjects. The use of iron and folate supplements was evaluated by questionnaire. Mean hemoglobin (+/- SD) in the sample was 123 g/L (+/- 1.0). The prevalence of anemia was 6%. Of the 21 anemic women, 11 were iron-deficient, giving an iron-deficiency anemia prevalence of 3%. Nineteen percent of women had low serum ferritin concentrations (< 12 micrograms/L) and 4% had low serum folate concentration (< 2.5 micrograms/L). Supplements containing iron were taken by 65% of women, and 63% were taking folate-containing supplements. Women in the second and third trimester taking folate-containing supplements had significantly higher serum folate concentrations compared to those not taking a folate supplement (p < 0.001). In the third trimester, women taking iron-containing supplements had significantly higher serum ferritin concentrations compared to those not taking an iron-containing supplement (p < 0.01). Our findings indicate that iron and folate status appears to be adequate in the majority of pregnant women in Switzerland, and that use of iron and folate supplements may have a positive impact on status.

[Clinical significance of serum carnitine in the course and prognosis of dilated cardiomyopathy]. / Klinische Bedeutung des Serumcarnitins für den Verlauf und die Prognose der dilatativen Kardiomyopathie.

Serum carnitine is an essential cofactor for the transport of free fatty acids into the mitochondria. We determined the free and the total serum carnitine in 99 healthy blood donors and 58 patients with different forms of heart muscle disease. Thirty patients had dilated (DCM), 10 hypertrophic (HCM) and 8 alcoholic (ACM) cardiomyopathy and 10 patients had congestive heart failure of different etiology than cardiomyopathy (CHF). Free and total serum carnitine were determined by an enzymatic-spectrophotometric assay according to Pearson. Mean values for free and total serum carnitine were as follows: 47 and 74 mumol/l in controls (C; blood donors), 74 (P less than 0.01 vs. C) and 83 mumol/l in DCM, 66 (P less than 0.01 vs. C) and 89 mumol/l in HCM, 85 (P less than 0.01 vs. C) and 104 mumol/l (P less than 0.05 vs. C) in ACM and 86 (P less than 0.01 vs. C) and 129 mumol/l (P less than 0.01 vs. C) in CHF. Ten patients died during the mean observation time of 13 months, 8 patients with DCM and 2 with CHF; 9 of these 10 patients had initially a markedly increased serum carnitine. Patients with DCM were divided into two groups with normal (n = 15; 25-68 mumol/l) and increased (n = 15; greater than 68 mumol/l) free serum carnitine. Patients with increased serum carnitine showed a significantly higher mortality rate (47%) than patients with normal serum carnitine. It is concluded that free and total serum carnitine are elevated in patients with congestive heart failure, dilated and hypertrophic cardiomyopathy. The etiology of this carnitine metabolism disturbance is unclear but it is probably due to a secondary phenomenon in patients with congestive heart failure or primary myocardial hypertrophy. An increased serum carnitine is a poor prognostic sign in patients with dilated cardiomyopathy.