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Chronic oral administration of high doses of levocarnitine in patients with severely impaired renal function or end-stage renal disease (ESRD) and dialysis patients may lead to accumulation of the potentially toxic metabolites trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), as these metabolites are normally excreted in the urine

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DPP4 and the RAAS are linked genetically and are associated with the risk of SARS-CoV-2 infection and possibly severity of COVID-19, particularly in patients with diabetes mellitus 76

That said, the standard medical recommendation applies: consult your OB-GYN or dermatologist before introducing any new active ingredient during pregnancy