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Glucose-6-phosphate dehydrogenase (G6FD) deficiency is an X-linked genetic disease that causes fragility of red blood cells, causing anemia due to hemolysis (destruction of red blood cells), although most of the time it is asymptomatic (AEHH 2012). It is transmitted by women and is more common in men.
It is the most prevalent enzyme deficiency in the world, exceeding 5% of the population in many countries (Nkhoma 2009).
Oxidative stress in the face of infections, excessive exercise or certain oxidizing substances can precipitate hemolytic crises, the substances most frequently implicated being certain medications such as Ascorbic Acid, Nalidixic Acid, Aspirin and Salicylates, Methylene Blue, Ciprofloxacin, Dapsone, Dimercaprol, Phenazone, Phenazopyridine, Phenylhydrazine, Glibenclamide, Glipizide, Menadione, Niridazole, Nitrofurantoin, Nitrofurazone, Primaquine, Probenecid, Quinine, Salsalate, Sulfamethoxazole, Sulfasalazine, Sulfisoxazole, Tafenoquine, Trimethoprim, or exposure to camphor or henna. Please consult www.g6pd.org for more information.
Fava beans (Belsey 1973), which contain vicin and convicin, and which are metabolized to products with a powerful oxidizing action, can trigger hemolytic anemia crises when ingested by people with a certain type of G6FD deficiency, which is why this disease is also known as favism.
Numerous cases of severe hemolytic crisis have been reported in G6FD-deficient breastfed infants after their mothers had eaten fava beans (Kaplan 1998, Schiliro 1979, Kattamis 1971, Taj-Eldin 1971, Emanuel 1961, Casper 1956), one case after the mother took aspirin (Harley 1962), and several cases after tonic water containing quinine was consumed (Bichali 2017).
Breastfeeding mothers with a personal or family history of G6FD deficiency or with infants diagnosed with this disease should not take the medications described and should not eat fava beans or drink tonic water containing quinine, or use camphor or henna.
Given the high global prevalence of G6FD deficiency (Nkhoma 2009), which is higher in certain ethnicities, it may be prudent to generally recommend that breastfeeding mothers avoid ingesting or coming into contact with these oxidizing substances (Wennberg 2017).
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