Pregnancy Food Safety

Which foods are dangerous -- and not so dangerous.

General Guidelines

Pregnant women should avoid or reduce their intake of certain foods. Most of us know this, and yet it can be incredibly frustrating trying to figure out what's "bad" and why. Every well-meaning family member, friend, and stranger is eager to give you their particular (often unsolicited) opinion about the vices and virtues of your diet, and every time you read a paper or watch the news, there's some new warning about lurking poisons in the foods you like to eat.

But at the end of the day, it often seems like a big game of telephone: incomplete or incorrect whisperings that leave you more confused than informed.

The main thing to remember, says nutritionist Maria Pari-Keener, MS, RD, of Maternal Health Matters in New York, is to practice moderation and good sense -- a good thing to remember when you're not pregnant as well!

Here are some general guidelines:

  • Wash all fruits and vegetables with water before use. Pari-Keener reminds us that this includes foods with inedible skins like cantaloupe and avocado. Cutting can transfer bacteria from the skin of fruits and vegetables into the flesh.
  • Cook foods thoroughly, especially those containing eggs, meat, chicken, or fish.
  • Wash hands with hot, soapy water before and after handling any meat or poultry products.
  • Check expiration dates for perishable foods.
  • Limit your intake of junk foods and other high-fat foods. Choose healthier alternatives (i.e., lower in fat and chemical content) that will still satisfy your craving.

Next: Fish

Fish

In March 2001, the Food and Drug Administration (FDA) issued an advisory that nursing mothers and women who are or may become pregnant should not eat the following kinds of fish because they may contain a harmful amount of methylmercury:

  • Shark
  • Swordfish
  • King mackerel
  • Tilefish

Mercury is a naturally occurring element. About half of environmental mercury occurs from vapors escaping the earth's core. Most of the rest is man-made mercury from smokestack emissions. Bacteria in fresh and salt water convert mercury into methylmercury, a toxic form that accumulates in fish. Larger, fatty fish tend to be a higher risk because they are older and have eaten more in their lifetime, and mercury is stored in fat. Eating a variety of small, young, nonfatty fish is safer.

Children under 6 years old and nursing women should also avoid these fish because of potential damage to a young child's nervous system, which could lead to developmental and learning disabilities.

Another pregnancy danger, listeria monocytogenes, is not only a hardy food-borne bacteria that can grow and survive under refrigeration, it is also a particularly dangerous bug for your unborn child. While you might only be felled with mild flu-like symptoms, listeria infection, or listeriosis, can cause miscarriage, fetal death, and severe illness or death of a newborn infant. Listeria is invisible and odorless.

Tuna

Many of us heard warnings about dangerous mercury levels in fresh and canned tuna as well as in the fish mentioned above. This is a controversial issue. While scientists and watchdog groups like the Mercury Policy Project have demanded tougher governmental guidelines about mercury levels in fish, including tuna, the FDA did not find sufficient evidence to include tuna on their list of high-risk fish. The Connecticut Board of Health, however, did add tuna to its list of high-risk fish, urging pregnant women in that state to limit their intake. If you are unsure of advisories in your state, call your local board of health or simply limit your tuna intake to one meal per week.

Sushi

Raw fish is a double no-no for pregnant women. In addition to concerns about mercury levels in some fish, uncooked or undercooked fish carries a greater risk for listeria contamination as well as hepatitis A.

Pick either a vegetarian or cooked-fish sushi if you like.

Smoked seafood

Refrigerated smoked seafood is also a potential carrier of listeria and, per the FDA and the U.S. Department of Agriculture (USDA), should also be avoided in its uncooked form. Refrigerated smoked fish, like salmon, trout, whitefish, cod, tuna, or mackerel, is usually labeled as "nova style," "lox," "kippered," "smoked," or "jerky."

Canned or shelf-stable smoked seafood may be eaten, as may any smoked fish that has been cooked.

Safe seafood choices

The FDA says that women can safely eat 12 ounces a week of the following kinds of fish:

  • Shellfish
  • Canned fish
  • Smaller ocean fish
  • Farm-raised fish

Fish from noncommercial sources

While the FDA's warning applies to commercial seafood bought in stores and restaurants, the Environmental Protection Agency (EPA) issued their own advice concerning fish from noncommercial sources, such as recreational fishers. High-risk groups, named above, should limit their consumption of all freshwater fish from these sources to one meal per week (8 ounces cooked fish per adult; 3 ounces cooked fish per child).

Next: Cheeses

Cheeses

The FDA has listed the following soft cheeses as among those to be avoided because they are more likely to be contaminated with listeria:

Mexican-style soft cheeses

  • Queso blanco
  • Queso fresco
  • Queso de hoja
  • Queso de crema
  • Asadero

Other soft cheeses

  • Feta (goat cheese)
  • Brie
  • Camembert
  • Blue-veined cheeses, like Roquefort

If you do eat a soft cheese, make sure it's cooked until bubbling. Otherwise, pick hard cheeses, such as cheddar. Pregnant women and small children can also safely eat processed cheeses, cream cheese, cottage cheese, and yogurt. With any cheese, make sure it's pasteurized and has been aged more than 60 days. Avoid "raw milk" (not aged and/or unpasteurized) cheeses.

Next: Sugars

Sugars

When you choose foods high in sugar or artificial sweeteners, it generally means you're not eating the more nutritious foods you need when you're pregnant. If you're craving something sweet, spread a little peanut butter on some whole wheat bread rather than picking a cookie or even diet soda, for that matter. Better yet, eat fruit.

But I need ice cream!

Let's be realistic. We all want to indulge in something sinful once in a while. That's fine. Just learn how to make choices that will leave you satisfied without throwing good nutrition down the drain. Pick an oatmeal raisin cookie instead of a Ring Ding, or a square of really good chocolate instead of a whole candy bar.

Gestational diabetes and sugar intake

If you're concerned that eating sweets will increase your chances of developing gestational diabetes, relax. While it's important for women who have this pregnancy-related condition not to consume any sugary foods, gestational diabetes is usually caused by factors like a woman's prepregnancy age, weight, heredity, and placental hormones. It's not a result of your pregnancy diet.

Fruit juice

Some women drink more fruit juice when they are pregnant for a variety of reasons. Those who are lactose intolerant may choose to drink calcium-enriched orange juice instead of milk. A big soda drinker decides that juice is a healthier option. Juice may provide some nutrients, but it's mostly just a great source of sugar and calories. Eat more broccoli if you need calcium, and if plain old water won't satisfy your thirst, try sparkling water with a splash of fruit juice for sweetness.

Artificial sweeteners

Artificial sweeteners such as saccharine and aspartame have not been studied in the long term, so if you want to play it safe, it's best to avoid them while you're pregnant.

Other Considerations

Nitrates and nitrites

"The potential risk of nitrates and nitrites for all people, including pregnant women, has been blown out of proportion," says Pari-Keener. Additives such as sodium nitrite, found in hotdogs, cold cuts, and other processed foods, are used as a preservative to combat botulism, a deadly food-borne illness. Once nitrates are digested, they can potentially form possibly carcinogenic nitrosamines. The good news is that the formation of nitrosamines can be prevented by vitamin C. Food manufacturers have started adding antioxidants like ascorbate and sodium erythrobate to address the problem. Or simply use the opportunity to eat some much-needed fruit or veggies, many of which are good sources of vitamin C. A better reason to avoid foods with nitrites or nitrates is that they tend to be high in fat, which you definitely don't need.

Caffeine

There is no evidence to suggest that a moderate amount of caffeine ingested during pregnancy causes fetal harm. The recommended allowance of caffeine for pregnant women is less than 300 mg a day. This translates into about two to three cups of coffee or about four cups of tea. Cola drinks, chocolate products, and green tea all have minimal amounts of caffeine. Pari-Keener generally recommends that women not have more than two cups of coffee or tea a day. It may not harm your baby, but she believes it's unwise to have caffeine regulate your energy and possibly disrupt your much-needed sleep while you're pregnant.

Reheating foods

The USDA and FDA recommend that the following foods be reheated until steaming in order to eliminate the risk of contracting listeriosis. If they cannot be heated properly, they should be avoided.

  • Refrigerated pâtés
  • Meat spreads
  • Cold cuts
  • Deli meats like hotdogs and sausages
  • Prepared meat and poultry products are also potential listeria carriers

Reviewed 11/02 by Elizabeth Stein, CNM

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's health.

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