Advice abounds about what a woman can or can not eat during pregnancy. Women often ask me. “Do I need to stop eating sushi?” and “Is it really that dangerous to eat lunch meat?” It does sometimes feel like there are more and more foods to avoid in pregnancy, which can be frustrating. My answers to these, and many other common questions about foods to avoid in pregnancy are below.
Q: What is the concern over lunch meats, raw fish, and soft cheese?
These are foods to avoid in pregnancy because of the possibility of food borne illness. They are not the only foods that can carry bacteria which can make you sick, but they are the foods with the highest risk. Any food contaminated with enough bacteria to cause illness should be avoided in pregnancy. Any food-borne illness is going to be extremely unpleasant during pregnancy when our digestive system is so sensitive. Dehydration is also a possible risk of any food-borne illness. Avoid food-borne illness in general by eating hot foods when they are hot and cooling hot foods quickly for storage. Avoid restaurants with unclean food practices and buffets with unclear food handling policies. Watch expiration dates, and when-in-doubt, throw it out. Avoid items with a long shelf life, such as deli meats treated with preservatives.
Q: What is the risk of Listeriosis in pregnancy?
Listeriosis is a type of food-borne illness that presents a much greater risk than other food-borne illness. The primary bacteria of concern is listeria. Listeriosis is super unpleasant for anyone, but for those with a strong immune system it is not usually a series disease. Listeriosis in pregnancy is a different story. Listeriosis in pregnancy presents a 50% chance of miscarriage or stillbirth, so the repercussions are much more critical.
There are 1000 cases of listeriosis reported in the US per year. Of those, pregnant women make up 27%, so you can figure that means 270 women become infected with listeriosis in pregnancy each year, and approximately 135 unborn babies die. This represents a very small percentage of miscarriages. There are 6 million pregnancies in the US every year, resulting in 4,058,000 live births and 1,995,840 miscarriages or stillbirths. But it is a preventable cause of miscarriage.
Avoiding Listeriosis in Pregnancy
The risk of contracting listeriosis in pregnancy is nearly 100% preventable. Listeria can live on high protein foods such as meat and dairy. Cooking kills listeria. To decrease the risk of listeriosis follow the following guidelines, including some foods to avoid:
- Cook ready-to-eat meats such as deli meats, hot dogs, & smoked meats, including fish: Heat to steaming just before eating. Any method of heating is fine, including microwaves, toasting, boiling, grilling or stove top. In recent years turkey has been the most contaminated deli meat.
- Avoid Unpasteurized Dairy: Avoid all unpasteurized milk.
- Be Cheese Savvy: Any cheese is considered safe if it was made with pasteurized milk. Any cheese labeled “raw milk cheese” is considered unsafe. Other cheeses typically made from unpasteurized milk include the soft cheeses such as feta, brie, goat and soft Mexican cheeses. Most of these are available in products made from pasteurized milk, and if they are their label will say “made with pasteurized milk.” Reading labels is the only way to know if a cheese is made from unpasteurized milk. Generally if a soft cheese does not state it was made with pasteurized milk it should be assumed to have been made with unpasteurized milk.
- Cook Eggs: Cook eggs until both the whites and the yolk are cooked through and firm to the touch.
- Avoid Raw Fish: Avoid all raw or undercooked fish. Fish should not be translucent.
- Check Expiration Dates: Meats with a long shelf life and expired meats are at a higher risk for listeria contamination. Check expiration dates on packaging and avoid post-date meats or meats that are meant to last for greater than 6 months.
I have worked with women who are passionate about the health benefits of raw egg and raw milk. While there seems to me to be authentic merit in these health benefits, the risk of listeriosis is there. Buying from a local source where you can personally observe the sanitation standards and growing conditions is recommended, although I do not have any information on the degree of safety this grants. Avoiding raw milk and eggs during pregnancy does not mean that you cannot enjoy these benefits before or after pregnancy, and as in most things it is long-term habits that have the greatest impact.
Q: What about sprouts during pregnancy? How do I avoid E. coli in pregnancy?
Are sprouts really one of the foods to avoid in pregnancy? The caution about sprouts is related to concerns about E. coli in pregnancy, not listeriosis. In addition to contracting E. coli from undercooked meats and dairy, you can become infected with E. coli in pregnancy by eating raw sprouts or other fresh and unwashed vegetables, by swimming in water contaminated with feces, or contacting feces at a petting zoo. Because of this, some web sites caution pregnant women not to eat nutrition-packed sprouts. There is no evidence that E. coli causes birth defects or crosses the placenta. Obviously it would be best avoided, just like any serious illness, but there are no particular concerns about E. coli unique to pregnancy. For a far more detailed, and passionate, discussion on sprout safefy check out this commentary on sprouts from the Sprout People.
Q: Should I eat fish during pregnancy? What about mercury in fish?
The EPA and FDA advise women to restrict their intake of fish to 12 oz a week for commercially caught fish and 6 oz a week for recreationally caught fish, but fish is not one of the foods to avoid in pregnancy. In our country, this recommended amount of fish is more then what most women consume, and the average levels of mercury found in our bodies are very low. There have been studies done in small populations where mercury levels are high, and children with high mercury levels, when compared with children who eat a diet low in fish, show positive neurodevelopmental outcomes. The hypothesis is that the beneficial aspects of fish-based nutrients outweighed the detrimental effect of neuro-toxins such as mercury. In the light of this evidence, it seems that the best advice for pregnant women is to consume a moderate amount of fish – approximately 3-7 servings a week. It is best to eat fish known to be less contaminated, such as Alaskan Chinook, Coho, Sockeye, and Pink Salmon (Arnold). Monteray Bay Aquarium publishes a very handy Seafood Watch App you can download, which will help you make great fish choices. Eat fish!
Q: Can I drink caffeine?
Caffeine disrupts homeostasis in the body. It should be avoided in high amounts, but a cup of coffee or two cups of tea will not hurt anything. (Read more about my tea recommendations below.) Chocolate in moderation is fine.
Q: Are herbal teas safe to drink?
I have a article specifically addressing concerns about herbal tea and pregnancy that summarizes much of the advice out there about this topic.
Q: What about non-herbal teas?
Black, Green and White tea contain caffeine, though not as much as coffee. Caffeine should be limited during pregnancy. I have also read that green tea can inhibit the uptake of folic acid, which is very important in pregnancy… however I have been unable to find a respected source for that information. It is important to drink plenty of plain water because non-herbal teas encourage the body to get rid of water. Again, moderation is prudent, but teas are a healthful beverage with beneficial antioxidants and need not be avoided altogether during pregnancy.
Q: Do I need to cut salt out of my diet
No, not unless your doctor specifically recommends limiting your salt for personal reasons. Salt is an important regulator of fluid volume. Pregnancy is a time of lots of change in our body fluids and salt’s role is a crucial one. Salt does not need to be increased, but should not be restricted either. Eating natural sea salt or crystal salt also supplies important trace minerals. Cheap table salt as sold in traditional grocery stores is stripped of these beneficial nutrients and uses chemical processing. Avoid cheap table salt and high-sodium processed foods, but use sea salt or crystal salt to taste.