Quinine-containing sodas may induce G6PD in breastfed children

Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is the most common human enzyme defect. To date there are a total of nine different forms known with some 140 different genotypes, all found on the long arm of the X chromosome on band Xq28.

One form is known as favism as a result of consuming fava beans. It is defined as an X-linked recessive inborn error of metabolism that predisposes to hemolysis (spontaneous destruction of red blood cells) and resultant jaundice in response to a number of triggers, such as certain foods, illness, or medication. There is no specific treatment, other than avoiding known triggers.

One of these triggers is, of course, the fava bean (or broad bean). The second one is stress from a viral or bacterial infection. Some drugs may also trigger acute hemolysis in people with G6PD deficiency.

There is a known link between G6PD deficiency and malaria. People with G6PD deficiency are more protected against malaria[1]. So, while G6PD deficiency may result in a potentially fatal acute hemolysis, the same deficiency offers protection against malaria. It's simply a trade-off between two ills.

But antimalarial drugs can also trigger acute hemolysis in people with G6PD deficiency. If you are breastfeeding your child with (an as yet unknown) G6PD deficiency, please remember that maternal consumption of a tonic soft drink which contains (just a bit of) quinine, may induce a G6PD crises[2]. It is recommended that consumption of quinine-containing sodas should be avoided during breastfeeding in populations with a high prevalence of G6PD deficiency.

[1] Huheey, Martin: Malaria, favism and glucose-6-phosphate dehydrogenase deficiency in Experimentia – 1975
[2] Bichali et al: Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children in European Journal of Pediatrics - 2017