Food Safety During Pregnancy - Part 2: Foods to avoid and what to do instead.
Co-Written by Emily Stevens, Dietetics Student
While my nutrition approach is typically looking at what we can include, or add in, rather than foods to eliminate or restrict - pregnancy is a bit of an exception as there there are a few foods that we may want to avoid for safety.
If you missed part 1 of this series, click here to read it now.
If you are recently pregnant, you have likely spent a fair amount of time on google wondering what is and isn’t safe to eat. With so much contradicting information from the internet, co-workers, and family members, it can be challenging to navigate this space and make your own decisions.
Trying to take in this information can feel overwhelming, and you might be left wondering what foods you can actually eat, and which ones should be avoided for the next nine months (and why!).
The tips and information below will aim to educate and empower you to make your own informed decisions and continue to enjoy food through your pregnancy stress-free!
Why is there an increased risk during pregnancy?
During pregnancy, a woman’s immune system becomes compromised. This decrease in immune function leads to an increased risk of contracting various food borne illnesses such as listeria, salmonella, Toxoplasma gondii, and campylobacter (1). Food borne illnesses in the general, healthy population, often present as unpleasant gastrointestinal symptoms such as nausea, vomiting, cramps, and fever. However, in individuals at higher risk, including pregnant women, food borne illnesses can lead to more severe symptoms and complications.
In pregnant women, a food borne illness can pose a threat to both the mother and the developing baby, and can increase the risk of preterm labour, miscarriage, low birth weight, and other pregnancy complications (1). While this may sound scary, the good news is that there is a lot we can do to avoid these illnesses during pregnancy, including proper food handling and preparation.
There are a few main groups of foods we typically want to avoid during pregnancy because of the increased risk of one of the above 4 foodborne illnesses. They include:
1. Soft cheese: This may include cheeses such as brie and camembert, semi-soft cheeses such as Havarti, including all unpasteurized, blue-veined cheeses (3,4). These cheeses have been associated with a higher risk of listeria (2). The risk is highest with unpasteurized cheeses, but these soft cheeses still carry a risk when pasteurized due to the higher moisture content.
Try this instead: Pasteurized cheeses, including cheese curds, cheddar cheese, and cottage cheese (3,4). Hard cheeses such Romano and Parmesan and processed/spreadable cheeses such as cream cheese (4). If you really want some brie, make sure it’s pasteurized and heat it to steaming hot (165°F) just before serving to reduce the risk.
2. Raw and unpasteurized milk products: Unpasteurized dairy products carry an increased risk of listeria and campylobacter (2,3). This may include various types of yogurts and milk. Luckily, all store-bought milk must be pasteurized in Canada before it can be sold (5), making it easier to find safe products to consume during pregnancy. If in doubt, check the label to make sure it says pasteurized!
3. Deli meats and hot dogs: Deli meats and hot dogs carry a greater risk of carrying listeria bacteria (2,3). This may include hot dogs straight from the packaging (raw), non-dried deli meats including bologna, roast beef, and turkey breast (4).
Try this instead: If you would like to continue to enjoy eating hot dogs, ensure that they are cooked to an internal temperature of at least 165°F and pay careful attention not to spread any juices from the hot dog package onto other food or preparation surfaces (4). Deli meats that are typically considered safe include dry varieties such as salami and pepperoni (4). If you are consuming other deli meat types, ensure that they are well heated before consumption (4).
4. Eggs and egg products: Eggs carry an increased risk of contracting listeria and salmonella if they are raw or lightly cooked (2,3,4). Examples of foods that may contain undercooked or raw eggs include cookie dough, cake batter, sauces and salad dressing (such as mayonnaise and hollandaise sauce), and eggs prepared with a runny yolk (4).
Try this instead: Ensure that all egg dishes you are preparing are cooked to a safe internal temperature of 165°F. If you are enjoying a poached or fried egg, ensure that the yolk is firm (4). Where possible, choose pasteurized eggs and egg products (4). Shelf stable, store bought mayonnaise is typically safe, though double check that the label says it uses pasteurized eggs.
5. Undercooked meat and poultry: Undercooked meat and poultry carry an increased risk of listeria, salmonella, campylobacter, and toxoplasmosis (2,3).
Take these steps to prevent infection: To prevent infection from these food borne illnesses, ensure that meat and poultry are cooked well to their proper internal temperature. A list can be found here (5). It is also essential to ensure your cooking space is free of cross-contamination when handling raw meats or poultry. Be sure to use separate cutting boards and utensils when preparing raw meats, and clean these utensils thoroughly, along with your counter area, and hands (2).
6. Seafood: Seafood can carry an increased risk of listeria, salmonella, and campylobacter (2,3). This can include raw seafood such as sushi, raw oysters, clams, and mussels or refrigerated and smoked seafood.
Try this instead: Ensure any seafood is cooked to a safe internal temperature of 165°F (4). If you want to enjoy oysters, clams, or mussels, ensure that they are cooked until the shell has opened, and enjoy them while still warm (4).
7. Sprouts: Sprouts carry an increased risk of salmonella (2). This may include alfalfa, clover, radish, and mung beans (4).
Try this instead: While raw sprouts can be a tasty and crunchy addition to salads, sandwiches, or other dishes, it is safest when pregnant to thoroughly cook your sprouts before consuming if you choose to include them (4).
8. Pâtés and meat spreads: These products carry an increased risk of listeria (2). It is best to avoid during pregnancy, or:
Try this instead: only consume pâtés and meat spreads that are sold in cans or that do not have to be refrigerated until they are opened, and eat then soon after opening the can (4).
9. Unpasteurized fruit juice and cider: These products tend to carry an increased risk of listeria and salmonella (2).
Try this instead: Choose only pasteurized fruit juice and cider or bring unpasteurized fruit juice and cider to a rolling boil (and then cool), prior to consumption (4).
10. Unwashed fruits and vegetables: Salmonella and toxoplasmosis bacteria can often be found in soil (2). Because of this, unwashed fruits and vegetables carry an increased risk of being infected with these bacteria.
Try this instead: Ensure all fruits and vegetables are thoroughly washed prior to preparing for consumption. No need to use fancy fruit washes or soaps, simply giving them a good rinse and scrub under the tap will do.
In addition to avoiding certain foods to reduce the risk of a food borne illness, caution should be taken with the following foods as well, to ensure a safe and healthy pregnancy:
Mercury in fish – While fish is an excellent source of omega-3 that is important for brain development, it is essential to be mindful of fish with high mercury content during pregnancy (1,3). During pregnancy, it is best to avoid fish such as tuna, shark, marlin, swordfish, escolar, and orange roughy in servings more than 150 grams (or 5 ounces) per month (6). Canned light tuna, such as skipjack, is low in mercury and safe to consume in regular amounts.
Vitamin A – Vitamin A plays a vital role in developing your baby’s skin, eyes, and immune system (1,3). However, too much vitamin A can cause congenital disabilities, especially during the first trimester (1,3). During pregnancy, eating varied and balanced diets rich in dark green and orange vegetables and fruit typically provides enough vitamin A to allow for the healthy development of babies (3). To ensure you do not consume too much vitamin A during pregnancy, it is best to avoid extra vitamin A supplements outside of what is in your prenatal, as well as avoiding any fish liver oil supplements, or liver and liver products (3). If you choose to consume liver or liver products (such as liver sausages), they should be limited to 75 g per week (3).
Caffeine – During pregnancy, you may safely consume caffeine in small amounts (3). Consuming too much caffeine can be harmful to your baby (3). To ensure a safe and healthy pregnancy, it is best to limit caffeine to no more than 200-300 mg per day, equal to roughly a max of 2 cups of coffee or 4 cups of black tea (3). Keep in mind that caffeine can also be present in chocolate, soda, and energy drinks, and these would all contribute to that limit.
Alcohol – Alcohol consumption of any amount during pregnancy is typically considered unsafe (3). Any alcohol intake can have harmful effects on a developing baby as alcohol easily crosses the maternal bloodstream into the placenta (1). The effects of alcohol consumption on the baby may vary depending on the amount consumed and the baby's developmental stage (1). Some consequences of alcohol consumption can include developmental delays or growth abnormalities (1). Due to the high risk of alcohol, it is recommended to avoid its consumption during pregnancy altogether. Please reach out for support if you are struggling to avoid alcohol during your pregnancy.
Herbal products – Many herbal supplements and teas can negatively affect a developing baby and pregnancy—it is best to use caution and have a consultation with your doctor and dietitian before beginning any herbal supplement when trying to conceive or pregnant. The following herbs are considered safe in average amounts used during cooking, or as approximately 2-3 cups of tea per day (3): ginger, bitter orange/orange peel, Echinacea, peppermint, red raspberry leaf, rosehip, and rosemary (3). Aside from these herbs, it is recommended to avoid all others during pregnancy in supplemental or tea forms.
Soy – As part of a healthy and balanced diet, soy products and soy-containing products are typically considered safe (3). Soy supplements, however, are not recommended during pregnancy, such as soy protein or isoflavone supplements (3). May supplements are unregulated and may contain other harmful herbal products.
Although being pregnant places restriction your diet, following food safety guidelines can significantly reduce your chance of exposure and illness and protect your developing baby.
Pregnancy can be challenging, and there is a lot of information on what you should and should not consume. If you are feeling overwhelmed or unsure, chat with your healthcare provider and dietitian!
I always encourage my pregnant patients to email me any time if they are not sure if something is safe to consume or not - I am always here to support you and let you know what, if any, risks there are! Of course, I also trust my soon-to-be-moms that once you are empowered with this knowledge, you are more than capable of making your own decisions, and can choose for yourself what you are and are not comfortable with.
References:
1.de Seymour JV, Beck KL, Conlon CA. Nutrition in Pregnancy. Obstetrics, Gynaecology, and Reproductive Med. 2019;29(8): 219-224.
2. Dean J, Kendall P. Food Safety During Pregnancy [Internet] Food and Nutrition Series: Colorado State University; 2006; [cited 2021 Mar 27] Available from: https://mountainscholar.org/bitstream/handle/10217/195894/AEXT_ucsu2062293722006.pdf?sequence=1
3. HealthLink BC. Healthy Eating Guidelines for Food Safety during Pregnancy [Internet] PEN: The Global Resource for Nutrition Practice: HealthLink BC; 2015; [cited 2021 Mar 27] Available from: https://www.healthlinkbc.ca/hlbc/files/healthyeating/pdf/food-safety-during-pregnancy.pdf
4. Health Canada. Safe Food Handling for Pregnant Women [Internet] Health Canada; 2015; [cited 2021 Mar 27] Available from: https://www.canada.ca/content/dam/canada/health-canada/migration/healthy-canadians/alt/pdf/eating-nutrition/healthy-eating-saine-alimentation/safety-salubrite/vulnerable-populations/pregnant-enceintes-eng.pdf
5. Government of Canada. Safe Cooking temperatures. [Internet] Government of Canada; 2020; [cited 2021 Mar 27] Available from: https://www.canada.ca/en/health-canada/services/general-food-safety-tips/safe-internal-cooking-temperatures.html
6. HealthLink BC. Mercury in Fish [Internet] Nutrition Series: HealthLink BC; 2018; [cited 2021 Mar 27] Available from: https://www.healthlinkbc.ca/hlbc/files/documents/healthfiles/hfile68m.pdf
