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.