by Anne Eglash MD, IBCLC, FABM

Do breastfeeding mothers need to avoid certain foods, medications or other substances if the infant is G6PD deficient?

G6PD (glucose-6-phosphate dehydrogenase) deficiency is a genetic disorder that causes insufficient amount of the G6PD enzyme in red blood cells. Lack of this enzyme can cause the red blood cells to break apart (hemolyze) when the individual is under physical stress, or exposed to certain foods, medications, and other substances. Symptoms include anemia, jaundice, and dark urine when hemolysis occurs.

Most newborn infants in the United States are not routinely tested for this genetic deficiency, since most states do not include this test in their panel of newborn metabolic screening tests. It occurs in approximately 10% of individuals from various geographic regions of Africa, the Middle East, Asia, the Mediterranean, and Papua New Guinea.

Infants in the United States are often diagnosed when they develop symptoms, especially severe, prolonged jaundice and/or anemia. Testing for G6PD deficiency is more accurate if done after the crisis, not while the infant is symptomatic.

People with G6PD deficiency need to avoid certain foods, medications and other substances that can trigger an onset of hemolysis. A breastfeeding mother who is not G6PD deficient can have an infant who is G6PD deficient. She needs to avoid certain foods and other substances in her diet to avoid creating a G6PD crisis in the infant.

Which foods and substances do you think can trigger symptoms of G6PD deficiency in an exclusively breastfed infant, if consumed by the mother? Choose one or more:

  1. Tonic water
  2. Fava beans
  3. Ibuprofen
  4. Penicillin
  5. Nitrofurantoin
  6. Sulfa
  7. Corn

See the Answer

 
The answers are A, B, C, E, F (not D or G)

Read the Abstract

Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children.

Eur J Pediatr. 2017 Aug 21. doi: 10.1007/s00431-017-2998-5. [Epub ahead of print]
Bichali S1, Brault D2, Masserot C3, Boscher C1, Couec ML4, Deslandes G5, Pissard S6, Leverger G3, Vauzelle C7, Elefant E7, Rozé JC1, Cortey A8, Chenouard A9.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect often presenting with neonatal jaundice and/or hemolytic anemia. G6PD hemolytic events are linked with exposure to a pro-oxidant agent. We here report three cases of initial G6PD crises in breastfed children secondary to maternal consumption of a tonic drink which contains quinine. Quinine was found in breast milk of one of the mothers after she consumed tonic water.

CONCLUSION:
The amount of quinine that is transmitted through breast milk appears to be sufficient to induce G6PD crises in breastfed children. We hence recommend that consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency.

  • What is Known:
  • G6PD hemolytic events are linked with exposure to a pro-oxidant agent.
  • Ingestion of fava beans by a mother who was breastfeeding has been reported to induce a neonatal G6PD crisis.
  • What is New:
  • Maternal consumption of tonic drink which contains quinine appears to be sufficient to induce G6PD crises in breastfed children.
  • Maternal consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM

Breastfeeding specialists who work in regions of the United States with more racial and ethnic diversity are more likely to have patients/clients with G6PD than those who work with populations that are largely Caucasian/Northern European.

Infants who have prolonged or severe newborn jaundice should be tested for G6PD deficiency. Exclusively breastfed infants who have a sudden onset of jaundice during the first 6 months, before they start solid food, should also be tested for G6PD deficiency, because infants with G6PD deficiency may have a crisis due to exposure of substances in mother’s breastmilk.

If infants have G6PD deficiency, and the breastfeeding mother does not, she needs education about avoiding all foods, medications, and substances that can cause a G6PD crisis, since these substances will end up in her breastmilk. A good source of information for foods, medications and other substances that can trigger a G6PD crisis is the G6PD Deficiency Association.

Oftentimes breastfeeding mothers are cared for by physicians who do not provide care for the infant. So, when prescribing medications for breastfeeding mothers, it is important to ask about the health of the infant, to make sure that the medication being given to the breastfeeding mother is not contraindicated for the infant. The best example is nitrofurantoin. Many women are treated over the phone via protocols for bladder infections, and nitrofurantoin is one of the most likely medications for urinary tract protocols. Although it is considered safe to use for breastfeeding women we need to remember to ask mom about possible G6PD in the infant, or to advise watching for jaundice in the infant, since nitrofurantoin can cause a G6PD crisis.

Comments (25)
Leave a Comment
Comments are moderated
Your email address will not be published. Required fields are marked *

Comments are closed for this question.