Pregnant women should steer clear of quinine-containing beverages!
The information “contains quinine” is stated on every tonic or bitter lemon beverage. But only few consumers will know why. Even if the enjoyment of quinine-containing beverages is not problematic for most of the population, the consumption of larger amounts can be harmful for some individuals. “Pregnant women, in particular, should refrain from consuming this substance for precautionary reasons”, says BfR President Professor Dr. Dr. Andreas Hensel. People who have been advised against quinine because of a specific clinical picture or an oversensitivity to cinchona alkaloids, should avoid quinine-containing beverages. In order to raise awareness amongst consumers about possible risks, BfR recommends that the previous labelling be extended to include specific information for pregnant women and other specific target groups.
Quinine is a bitter-tasting, crystalline powder obtained from the bark of the cinchona tree, Cinchona pubescens. In medicine the alkaloid is used to treat malaria and nocturnal calf muscle cramp. Quinine is also used as a flavouring mainly in tonics and bitter lemonades. In Germany non-alcoholic beverages may only contain a maximum of 85 milligram quinine per litre (mg/l).
When larger amounts of quinine are consumed, it can constitute a health problem. BfR sees potential risks in particular for pregnant women. In scientific literature there are reports of “withdrawal symptoms” in the case of a newborn baby whose mother had drunk more than one litre tonic water a day during her pregnancy. 24 hours after the birth, the baby was observed to suffer from nervous tremors. Quinine was detected in its urine. Two months later these symptoms could no longer be observed.
Quinine-containing beverages are popular thirst quenchers because of their slightly bitter taste. Larger amounts are consumed particularly in the summer months also by pregnant women. Furthermore, there are recommendations posted on the Internet expressly advising pregnant women to drink quinine-containing beverages in order to counteract nocturnal calf muscle cramp or early morning sickness. By contrast, BfR’s advice to pregnant women to avoid quinine-containing beverages on precautionary grounds is given in the context of quinine as a medicinal product – in this context pregnancy is a counter-indication.
People who are advised against taking quinine by their doctors because of specific clinical pictures like tinnitus, pre-existing damage to the optic nerve, certain types of haemolytic anaemia or oversensitivity to cinchona alkaloids should refrain from consuming quinine-containing foods. Anyone who suffers from cardiac dysrhythmia or takes medicinal products which interact with quinine like anticoagulant medicines, should only drink quinine-containing lemonades after consulting his doctor. According to BfR, these recommendations constitute an adaptation of health protection in the food sector to risk prevention measures from the medicinal product area.
Already today, quinine-containing products have to be labelled as such. BfR, however, believes that there is a need for more extensive information for risk groups and to raise awareness amongst consumers about possible adverse reactions to quinine, too. BfR is of the opinion that the population at large knows too little about the symptoms of quinine intolerance, the onset of which may already occur - in the case of an existing over-sensitivity - after consuming smaller amounts of quinine. The main adverse reactions to quinine intake are tinnitus, visual disturbances, disorientation, skin bleeding and haematomas. If these symptoms occur, no further quinine should be consumed and a doctor consulted.
A comprehensive expert opinion on the potential health risks linked to the consumption of quinine-containing beverages can be accessed on the BfR homepage on www.bfr.bund.de.