Can You Eat Sushi While Pregnant?

Photo: Kzenon/

Pregnancy comes with a long list of do’s and don’ts-some more confusing than others. (Example A: See what the experts have to say about whether you really have to quit coffee while you’re pregnant.) But one rule that’s pretty well agreed upon by doctors? You can’t eat sushi while pregnant-which is why Hilary Duff’s recent Instagram post is causing so much controversy.

Earlier this week, a pregnant Hilary Duff posted a photo of her and a friend enjoying a spa day followed by a sushi dinner. Almost immediately, the comments exploded with concerns that Duff was eating raw fish, which medical experts advise pregnant women to avoid.

What’s wrong with eating sushi while pregnant?

“Since sushi is made of raw fish, there is always the higher risk of parasites and bacteria,” says Darria Long Gillespie, M.D., an ER doctor. “While those don’t always cause a significant problem in adults, many of them can cause severe damage to the developing baby, which is why they’re scary. If the sushi was stored properly, then the risk should be very low, but there’s no benefit to eating sushi over cooked fish so, honestly, why risk it?”

If you do get sick from eating sushi while you’re pregnant, it can be really risky, says Adeeti Gupta, M.D., a board-certified gynecologist and founder of Walk In GYN Care in New York-it’s more serious than a run-of-the-mill case of food poisoning that you might get when you’re not pregnant. “Although the gut infections from bacteria including E. coli and salmonella that sushi may carry are treatable, they can be severe and can cause dehydration and affect the pregnancy,” explains Dr. Gupta. On top of that, these infections typically need to be treated with antibiotics, she adds, some of which aren’t safe to use during pregnancy.

Raw fish can also transmit listeria, a bacterial infection that’s more common in pregnant women and newborns, according to the Centers for Disease Control and Prevention. (See: 5 Things You Need to Know about Listeria.) During pregnancy (especially early-on), a listeria infection can be devastating. “It can cause miscarriage, fetal death and growth restriction,” says Dr. Gupta.

What about other fish?

The concern over bacteria only applies to raw fish, according to the experts. “Anything that has been cooked at a temperature high enough to kill the bad bacteria is safe,” says Dr. Gupta. “As long as the food has been cooked at an average above 160 to 170° Fahrenheit, it should be safe for consumption, provided it has not been handled by an infected person after cooking.” In other words, you don’t have to give up your favorite grilled salmon recipe for nine months-just your salmon avocado rolls.

That said, you should still limit your cooked fish consumption if you’re pregnant, says Dr. Gillespie. “All fish, whether cooked or raw, contain the risk of mercury ingestion,” she says. Exposure to mercury can harm the central nervous system-especially in the developing brain of a fetus, according to joint advice from the Food and Drug Administration and Environmental Protection Agency. Dr. Gillespie recommends limiting your cooked fish consumption to no more than one or two servings a week. And when you do nosh on cooked fish, opt for low-mercury varieties like salmon and tilapia. (For more recommendations, the FDA created a chart detailing the best and worst seafood to pick on the menu.)

The Final Word On Eating Sushi While Pregnant

Bottom line: Raw fish is a no-go (sorry, Hilary) if you’re pregnant. To cut down your risk of picking up a harmful bacteria, “stay away from raw and uncooked meats or seafood, unpasteurized cheeses, and make sure you thoroughly wash any raw salads or vegetable before consuming them,” says Dr. Gupta.

Technically, you can still have sushi that doesn’t include raw fish, like veggie rolls or cooked tempura rolls. But personally, Dr. Gillespie feels even this can be risky. Even if you really want to go to your favorite sushi spot and just get a California roll, remember that the chefs probably use the same countertops and knives to cut all the sushi, whether it had raw fish or not. So to be extra cautious, consider saving sushi night as a post-pregnancy treat. (Consider making these homemade summer rolls to fill your sushi-like craving instead.)

  • By Macaela Mackenzie @MacaelaMackenzi

Is it safe to eat sushi while pregnant?

Not if it’s made with raw fish.

Both the Centers for Disease Control and the Food and Drug Administration recommend that pregnant women only eat fish and shellfish that has been cooked to 145 degrees F. Cooking fish to this temperature destroys any potentially harmful parasites and pathogens (other disease-causing organisms such as bacteria and viruses).

Because your immune system is suppressed during pregnancy (which helps your body not attack your growing baby), you’re more susceptible to foodborne illnesses, such as Listeriosis.

Eating raw or undercooked fish or shellfish could result in an illness severe enough to cause a blood infection that could be life-threatening for you and your baby.

Raw fish that has been frozen is not safe during pregnancy, either. While freezing can destroy potentially harmful parasites, it does not kill pathogens.

Stick with sushi made only with vegetables or cooked fish.

Learn more:

Find out how to avoid mercury while eating fish during pregnancy.

Find out what’s safe to eat during pregnancy (and what’s not).

Coffee, sushi, and wine: What’s safe during pregnancy?

Every day, at least one pregnant patient tells me she’s tired or grumpy after giving up coffee, sushi, or another favorite food or drink to protect her growing baby. While such sacrifice is a noble gesture, it’s unnecessary for most women.

In fact, there is just a handful of foods and drinks we recommend that women totally avoid during pregnancy. With a little common sense, women can enjoy a wide menu without endangering their own health and the health of their babies.

3 common food and drink concerns during pregnancy

The following are general guidelines for the three foods and drinks my patients ask about most often. Every woman and every pregnancy is different, so I encourage women to talk to their doctor about dietary-related questions or concerns.

1. Caffeine

Moderate caffeine consumption – less than 300 mg per day, or right around two 8-ounce cups of coffee – is considered safe during pregnancy for most women. However, women who are breastfeeding during pregnancy might want to cut back on coffee, tea, and soda if the child becomes fussy or has trouble sleeping.

2. Alcohol

Drinking alcohol during pregnancy can be a touchy topic. Moderate to heavy drinking can contribute to pregnancy complications and birth defects, but the risks associated with low alcohol consumption are less understood. Because we can’t be sure whether alcohol is safe or in what quantities, it should be avoided all together.

3. Fish

Eating seafood that is high in omega-3 fatty acids is healthy during pregnancy when prepared properly. The current guidelines suggest that pregnant women can safely eat three servings a week (up to 12 ounces total) of shrimp, salmon, catfish, and other fatty fish. It’s even safe for most pregnant women to eat sushi in the U.S., provided it’s prepared in a clean environment. However, some fish is high in mercury, including king mackerel and swordfish. It’s not safe to consume mercury in high amounts during pregnancy because it increases the risk of birth defects.

While most foods and drinks are safe during pregnancy, a handful of foods should be avoided to reduce the risk of foodborne illnesses, or diseases caused by toxins, viruses, and bacteria. Below are tips to reduce the risk of three foodborne illnesses that harm pregnant women and their babies.

3 common foodborne illnesses and how to avoid them

1. Food poisoning

Food poisoning often is caused by consuming foods that are contaminated by viruses, toxins, or bacteria, such as salmonella. While diarrhea and vomiting are unpleasant for anyone, food poisoning during pregnancy also can cause headache, fever, and dehydration, which can result in hospitalization.

2. Toxoplasmosis

Toxoplasmosis is an infection caused by a parasite that can be carried in raw or undercooked meats. Some pregnant women experience mild symptoms; others experience none. However, toxoplasmosis can cause pregnancy complications such as miscarriage or stillbirth or health problems for the baby, including blindness or cognitive issues.

3. Listeria

Pregnant women are more susceptible than the general public to infection from Listeria, a bacterium found most frequently in deli meats, hot dogs, unpasteurized milk products such as soft cheeses, and unwashed produce. Regional outbreaks also have linked Listeria to less likely foods, such as hummus and ice cream. Symptoms of infection, if any, are often vague and flu-like. Untreated Listeria infection can increase the risk of premature delivery, miscarriage, and stillbirth.

Common sense food safety can help pregnant women avoid foodborne illnesses. Follow these tips to reduce the risk:

● Be aware of foodborne outbreaks in your area

● Clean food preparation surfaces and utensils before and after use

● Fully cook all meat dishes

● Keep cold food cold, and hot food hot

● Wash raw fruits and vegetables before cutting or eating them

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If you take raw and partly cooked shellfish out of the equation, the risk of falling ill from eating seafood is 1 in 2 million servings, the government calculated some years back; by comparison, the risk from eating chicken is 1 in 25,000. (Over all, 76 million cases of food poisoning are reported a year.)

The main risk of illness from non-mollusks isn’t from eating them raw. Rather, as the Institute of Medicine reports, the problem is “cross-contamination of cooked by raw product,” which is “usually associated with time/temperature abuse.” In other words, no matter what you order in a restaurant, if it’s not kept at a proper temperature and protected from contamination, you’re at risk.

Conversely, if the restaurant follows good food safety practices, there is little to worry about. Having been inside the kitchens of dozens of restaurants of all kinds for research, I can say that Japanese kitchens are, on the whole, the cleanest, the most careful and the most conscientious in the business. Moreover, sushi bars are out in the open for all to see, and anybody who has spent a few minutes observing a sushi bar and a typical American diner’s griddle area can tell you which type of restaurant has higher standards of cleanliness.

Sushi may not be cooked, but it has, for the most part, been frozen. Food and Drug Administration guidelines require that before being served as sushi or sashimi (or in any other raw form), fish be flash-frozen to destroy parasites. While the fish you see in the sushi-bar display case looks fresh, it has almost certainly been frozen at some point in the distribution system. This freezing kills any parasites as sure as cooking would.

Most species used for sushi don’t have parasites anyway, though. Fish like tuna are not particularly susceptible to parasites because they dwell in very deep, very cold water, and sushi restaurants typically use farmed salmon to avoid the parasite problems wild salmon have. Most of the fish likely to have parasites, like cod and whitefish, aren’t generally used for sushi. Nor does pregnancy increase susceptibility to parasites. Healthy women who’ve been eating sushi are not at increased risk when they become pregnant. The same resistance and immunities function before, during and after pregnancy.

Being pregnant comes with a bunch of restrictions—probably no water skiing, OK?—but our society seems to think it’s everyone’s business whether or not you’re abiding by those standards. So you can probably imagine the public outrage after a pregnant Hilary Duff dared to share a Boomerang on Instagram in which she’s in the vicinity of some sushi.

In the clip, Duff and a buddy toast each other while wearing robes. They’re also seated at a low table in front of what appears to be plates of sushi and rolls. “Had the dreamiest of nights with this babe @tomoko_spa + @moflo1wooooow weeeee #couplesmassage lol #tomokospa,” she captioned the shot. It’s not immediately clear what’s in those sushi rolls or whether or not Duff consumed any of it.

And naturally, people freaked the eff out. “Veggie-only sushi I hope. No sushi while pregnant,” one wrote. “Wait, sushi when you’re pregnant?” another said. Others stuck up for Duff and pointed out that she could have been having vegetable sushi or that maybe she had no plans to eat the food that was in front of her.

The social media drama stems from the fact that it’s recommended that people avoid raw sushi while pregnant.

This recommendation comes courtesy of the American College of Obstetricians and Gynecologists (ACOG), which specifically has this to say on the topic: “Avoid all raw and undercooked seafood, eggs, and meat. Do not eat sushi made with raw fish (cooked sushi is safe).”

One big worry about this, according to ACOG, is food poisoning while pregnant. That’s because the diarrhea and vomiting that can come along with a foodborne illness can cause your body to lose too much water, causing dehydration, ACOG explains.

And dehydration during pregnancy is no joke: It can lead to serious complications like neural tube defects, low amniotic fluid, and even premature labor, the American Pregnancy Association says. So, as always, being careful about the quality of the fish you’re eating and having adequate medical care should something be a little off is important.

Some types of fish are also more likely to carry mercury risks than others.

Some types of fish have higher levels of mercury, and mercury has been linked to birth defects, ACOG points out, so it’s important to limit your exposure where possible. Higher-mercury fish include swordfish, king mackerel, marin, orange roughy, and tilefish. These feed on smaller fish that have accumulated mercury, Dana Hunnes, R.D., Ph.D., M.P.H., a senior dietitian at Ronald Reagan UCLA Medical Center and an adjunct assistant professor at the UCLA Fielding School of Public Health, tells SELF.

Is it safe to eat seared, smoked, or raw fish during pregnancy?

No. Both the Centers for Disease Control and the Food and Drug Administration recommend that pregnant women only eat fish and shellfish that has been cooked to 145 degrees F. Cooking fish to this temperature destroys any potentially harmful parasites and pathogens (other disease-causing organisms such as bacteria and viruses).

Fish that is “seared” is typically not fully cooked throughout and is thus not cooked to a safe temperature. Some types of smoking also do not cook fish to a safe temperature, so you’ll want to avoid smoked fish as well. You’ll also want to avoid raw oysters and sushi made with raw fish.

Because your immune system is suppressed during pregnancy (which helps your body not attack your growing baby), you’re more susceptible to foodborne illnesses, such as Listeriosis.

Eating raw or undercooked fish or shellfish could result in an illness severe enough to cause a blood infection that could be life-threatening for you and your baby.

Raw fish that has been frozen is not safe during pregnancy, either. While freezing can destroy potentially harmful parasites, it does not kill pathogens.

Cook fish to an internal temperature of 145 degrees F (63 degrees C). When a food thermometer is not available, follow these tips to determine when seafood is done:

  • Cook fish until it’s opaque (milky white) and flakes with a fork.
  • Cook shrimp, lobster, and scallops until they reach their appropriate color. The flesh of shrimp and lobster should be an opaque (milky white) color. Scallops should be opaque (milky white) and firm.
  • Cook clams, mussels, and oysters until their shells open. This means that they are done. Throw away the ones that didn’t open.
  • Shucked clams and shucked oysters are fully cooked when they are opaque (milky white) and firm.

Finally, you’ll want to avoid certain fish (such as swordfish) even when cooked, because they can contain potentially risky levels of methylmercury. Studies show that exposure to high concentrations of methylmercury during pregnancy can impair a baby’s growing brain and nervous system. (Read more about avoiding mercury while eating fish during pregnancy.)

Learn more:

Find out what’s safe to eat during pregnancy (and what’s not).

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Most of Dr. Nathan Fox’s patients have high-risk pregnancies. They may be having twins, or they’re dealing with complications such as high blood pressure or diabetes. Still, he spends a lot of time in his New York practice answering the little questions that seem to nag at nearly all expectant mothers:

Should I eat fish? What kind and how much? What about coffee? Or sushi? What if I forget to take my prenatal vitamin? Will I hurt my baby if I sleep on my back? If I go swimming? If I have sex? If I fly?

“There is so much misinformation that is given to women by the media, by things they read, by their friends, by their family — obviously now with the internet, they’re finding stuff — and even by doctors,” Fox says.

Add to that the societal pressure to do everything just right during pregnancy and the deep desire to make the best choices — the right choices — for their child, and it’s a distressing mix, he said.

To cut through misconceptions and to help other medical staffers put women’s minds at ease, Fox has written a paper based on the medical literature that answers the questions he hears most often, briefly and in lay language. Published this month by the journal of Obstetrics & Gynecology (widely known as “The Green Journal”), it distills the latest research on 19 topics and makes clear where data is lacking.

“This is a very balanced review,” said Dr. Aviva Lee-Parritz, chief of the department of obstetrics and gynecology at Boston Medical Center.

The list includes some commonsense reminders, she said, including that pregnant women, like everyone else, should wear a seat belt. (The small potential risk to the developing baby from wearing one is outweighed by the significant risk of being in an accident without one.)

And, Lee-Parritz said, it counters some of the cultural messaging that pushes women to be overly restrictive during pregnancy.

Women looking for absolute answers won’t find many here. In most cases, readers still need to decide for themselves how much uncertainty they can manage. But Fox offers a concise tool to help — and definitely more reliable data than the commenters in that online pregnancy forum you’ve been trawling. The full article is here, but his main points include:

• Don’t worry if you miss a prenatal vitamin. Pregnant women need to be sure they get adequate amounts of folic acid, vitamin D, iron and calcium. If you have a healthy diet, a prenatal vitamin may not do much for you or your baby. Vitamin supplements are important for women who are undernourished. For those with a nutritious diet, it “is likely not required,” Fox writes.

• Avoid alcohol (but that one glass of wine is probably OK). Heavy drinking is clearly linked to problems in the fetus. But Fox points to several large studies that have found no link between a mother’s light or moderate drinking and developmental or behavioral problems in their children later in life.

“It doesn’t mean there are zero problems with it,” Fox said. “It just means that we have never been able to find one.” So what does he tell his patients who ask about having a glass of wine here and there? He can’t promise it’s perfectly safe, but it doesn’t appear to be dangerous.

• Do indulge in that morning coffee. Another beverage, another moral dilemma. Most data suggests that low-to-moderate caffeine consumption is safe, Fox writes.

Dr. Monica Mendiola, an OB-GYN at Beth Israel Deaconess Medical Center, said she tells her patients who are regular coffee drinkers that they can drink a cup of coffee daily or take a Tylenol to cope with the headaches they’ll have if they stop. Neither is harmful.

• Sure, have some sushi. And eat fish — the cooked kind — regularly, but avoid species that are high in mercury. Warnings against eating raw fish during pregnancy are mostly prompted by fear of parasites that are uncommon in developed countries and “are also not particularly dangerous,” Fox writes.

• Don’t do bed rest. Even if your grandmother says you need it, you almost certainly do not. Bed rest once was recommended for a wide variety of complications and concerns during pregnancy. The latest data shows it is not beneficial in preventing preterm birth or pregnancy loss, and it could be associated with risks, Fox writes.

• Do exercise. It’s good for you. Fox recommends an average of 20 to 30 minutes of moderate-intensity exercise — that means you can still talk while doing it — four or five times a week.

• Do feel free to get it on. For many women, there comes a point when you just can’t. You’re too big, too tired, too — everything. But there’s no medical reason to avoid sex at any point in pregnancy, for most women.

Fox writes that it’s not clear whether sex could increase the risk of bleeding or infection in women who have vaginal bleeding or whose membranes have ruptured. And while there are no clear data to support it, doctors generally recommend that women whose cervix is covered by the placenta, called placenta previa, avoid sex after 20 weeks to prevent bleeding.

• Do travel, if you’d like. Air travel is safe while pregnant, Fox writes. Compression socks and getting up frequently is a good idea on longer flights. Whether (or when) to stop traveling as the end of pregnancy approaches — and as the risk of some complications increases — is an individual choice, to be weighed against the benefit of the trip, Fox writes.

As for the newer backscatter X-rays at security? No need to forgo them for a patdown, Fox said. The radiation exposure from the scan is about 1/600th the amount of cosmic radiation received during the flight itself.
• Don’t smoke cigarettes. They’re not good for anybody. If you can’t quit entirely, then reduce smoking as much as possible, Fox writes. Nicotine replacement is acceptable for cessation. Vaping, sometimes used to quit cigarettes, may not be. There is not adequate research on vaping’s effect on pregnancy, Fox writes: “Logically, (electronic nicotine delivery systems) should not be more dangerous than smoking, but it is possible they are not as safe as other nicotine replacements such as patches and gum.”

• Marijuana is probably not a good idea, either. It is not linked to any adverse outcomes, but it also hasn’t been studied enough, Fox writes. Marijuana use among pregnant women has been growing in the United States. And some have used it to deal with nausea during pregnancy. Beth Israel’s Mendiola said there are other ways of dealing with nausea. “Just because we don’t know what is causing, doesn’t mean it’s not causing harm,” she said.

• Don’t panic when you wake up on your back. Many pregnant women go to bed each night with a pile of pillows and a mantra of “left is best” playing in their head. It’s thought that lying on the left side aids circulation to the baby and lying supine is linked to stillbirth.

But, Fox writes, the studies that made that link were limited because they were based on what women recalled about their past behavior, which can be imperfect. Plus, Fox writes, there’s no data that shows side-sleeping actually prevents stillbirths.

Mendiola said she hears often from women worried that they started out the night on their side and woke up on their back. Her response is simple: “That’s OK.”

Chelsea Conaboy is a freelancer who writes often about health care. Find her at chelseaconaboy.com and on Twitter @cconaboy. Photo via il-young ko via Flickr.

If there’s one thing pregnant women are constantly worried about, it is their diet. This is understandable, considering that what you eat is all the source of food that your baby will get. It is imperative that you keep a tab on everything you consume. Salmon is a hot favourite among the most, and for good reason. It is tasty, nutritious, andversatile. It is also widely available, and the number of dishes you can make with this fish is innumerable.



Can Pregnant Women Eat Salmon?

We’ve established the fact that salmon is tasty and healthy, but is it advisable for pregnant women to indulge in this delicacy? The answer is yes! Salmon has a great nutritious value that can be highly beneficial for both the expecting mother and child. A low-fat fish, salmon happens to be one of the most nutritious fish available. In addition to this, it helps to keep a lot of diseases at bay, thereby protecting you and your baby.



Benefits of Eating Salmon While Pregnant

As mentioned above, salmon has a lot of health benefits, here are a few –

1. Rich in Omega-3 Fatty Acids

Omega-3 fatty acids are known for their many benefits, great cardiovascular health, improved eyesight, and enhancing neurological development being the most common advantages. Consuming this nutrient means good health for both you and your unborn baby.




2. Rich in Proteins and Vitamins

Proteins are extremely important for muscle growth and repair, and vitamins are highly instrumental in maintaining optimal blood pressure levels, preventing heart disease, and increasing immunity. In addition to this, vitamins are great for the eyes, skin, and hair and work as an antioxidant, thereby fighting toxins.

3. Great for the Heart

Salmon is great for the heart as it keeps a tab on blood pressure and cholesterol and prevents blood from clotting, especially in the arteries.





4. Helps Prevent Premature Delivery

Fish that have a low-fat content and high omega-3 fatty acid content are great for the body, and salmon is the perfect example of this. Research suggests that this fish, in particular, helps in preventing premature delivery.

5. High DHA Content

Salmon has a high content of Docosahexaenoic acid (DHA). This will aid in the brain development of your fetus. In addition to this, it can help prevent postpartum depression for the expecting mother.




Side Effects of Consuming Excess Salmon in Pregnancy

Too much of anything is bad, and this is something you must keep in mind especially if you are in the family way. Here are a few side effects of consuming excess salmon in pregnancy –

1. Excess Mercury

Salmon is one of the types of fish that contain the least amount of mercury. However, consuming salmon in excess can increase the amount of mercury in your system, so make sure you eat this fish moderately.





2. Could Contain PCB

PCB or Polychlorinated biphenyls are harmful to the body as they are carcinogenic in nature, which means they can cause cancer. Excess consumption of salmon can put you in the risk for this. PCB is also a causal factor in hindering the development of your foetus.

How Can You Include Salmon Fish in Your Pregnancy Diet?

There are several ways to prepare and include salmon in your pregnancy diet, but the best way to do so is broiling, poaching or baking it. Make sure you avoid raw preparations like sushi, as this puts you at a risk for bacterial infection. Consume this as a fillet with your rice and vegetables. Salmon salads filled with vegetables are a tasty option as well.




While it is best to avoid smoked seafood that has been refrigerated during pregnancy, there has been no negative correlation between smoked salmon and pregnancy as there is no evidence on why you should avoid it.

Precautions to Take While Having Salmon When Pregnant

Here are a few precautions that you must keep in mind while consuming salmon when pregnant.





  • Firstly, make sure you buy or order the fish from a trusted source. Even if you are buying from a local vendor, ask around to see if his fish are good. Before eating at a restaurant, check to see if it has good reviews, is clean and hygienic.
  • Make sure your salmon is well-cooked. Raw salmon while pregnant is dangerous as raw, uncooked food is a breeding ground for bacteria, germs, and virus You don’t want you or your fetus coming in contact with this.
  • Make sure you remove the skin of the fish. After this, make sure that the meat is cooked until it is dark.
  • Avoid cooking this fish with too much spice. Excessive consumption of spice is not good for you, especially if you are pregnant.

Taking care of yourself at this time should be high on the list of your priorities, as you are now not just responsible for yourself, but for your little unborn baby as well. Make sure you give yourself all the love and care that you truly deserve. Salmon is a great food, so go ahead and dig into this delicacy – but in moderation. Stay away from this food if you have an allergic reaction to it. Consult your doctor before consumption. If you’ve developed a reaction after consumption, make sure you go to the doctor immediately.

Also Read:




Is It Safe to Eat Prawns during Pregnancy?
Consuming Crab during Pregnancy
Eating Shrimp while Pregnant
Is Consuming Tuna Safe in Pregnancy?

Is It Safe To Eat Sushi During Pregnancy?

When people say that pregnant women should not eat sushi in pregnancy, they usually refer to sushi that contains raw fish. Sushi is not necessarily the same thing as raw fish. Most websites and many professional organizations say it’s not safe to eat sushi in pregnancy. However, there is often a misunderstanding of what sushi is. Rather, raw fish, known as sashimi in Japanese, is the most popular ingredient in sushi. However, there are many other organizations that say it’s safe to eat raw fish in pregnancy:

The British National Health Service NHS, an authority on health, states: “It’s usually safe to eat sushi and other dishes made with raw fish when you’re pregnant.”

There is no conclusive evidence in the published literature that eating sushi during pregnancy has a major adverse effect on the pregnancy or that pregnant women have more or different complications after eating sushi. There are few, if any, published reports on an adverse association between sushi and bad pregnancy outcomes. In simple terms: There is no scientific evidence that sushi can do harm when eaten in pregnancy.

According to PubMed and Motherisk: “..it is no longer necessary for pregnant women to avoid … sushi and sashimi. Regardless of whether seafood is raw or cooked, pregnant women should choose low mercury seafood (eg, salmon and shrimp) over higher mercury varieties (eg, fresh tuna). Pregnant women should ensure that their food is obtained from reputable establishments; stored, handled, and cooked properly; and consumed within a couple of days of purchasing.”

Before you go to an all-you-can-eat sushi bar, however, it’s important to be informed about the benefits and risks of eating sushi and raw fish during pregnancy.

Is sushi or raw fish healthy?

Eating sushi and raw fish is part of a healthy diet during pregnancy as long as you eat fish with safe mercury levels. There is no scientific evidence that eating sushi during pregnancy increases pregnancy complications.

In Japan, sushi is considered very healthy in pregnancy and there are many who believe that the American “pregnancy sushi ban” is insulting to Japanese culture. Fish contains fish oil that is beneficial to the fetus’ nervous system development.

Do people get sick from sushi or raw fish?

In general, people rarely get sick from eating sushi, but raw seafood is potentially risky because it can contain parasites such as tapeworm. Freezing and cooking kills most parasites, and many if not most Japanese restaurants in the US that specialize in sushi use frozen rather than fresh fish. You may want to ask your restaurant before ordering sushi if it has previously been frozen.

Parasitic worms and pregnancy

Occasionally, fish such as salmon may contain small parasitic worms, such as anisakis. Cooking the fish usually destroys the worm. If you eat raw or undercooked fish which may contain these worms then it can cause health problems that can happen to anyone, not just pregnant women.

Infection with these worms results in a condition known as anisakidosis (formerly known as anisakiasis or anisakiasis). Symptoms of anisakiasis include:

  • severe abdominal pain
  • nausea and vomiting
  • diarrhea

Eating fish contaminated with anisakis can also cause an allergic reaction. Freezing raw wild fish kills any worms that may be present and makes it safer to eat.

Aniskaosis has also been found in people eating raw or marinated anchovies. Anchovies are traditionally processed and preserved in salt and brine which does not always destroy the worms.

Sushi and PCB chemicals

One concern about seafood, raw or cooked, is PCB and chemical contamination. If you want to eat fish during your pregnancy, contact your local health department or office of the Environmental Protection Agency (EPA) for a list of fish in your area that hasn’t been contaminated with toxins. You may also want to avoid certain fish with higher mercury levels.
As a general rule, ocean fish such as tuna, sea bass, sole, flounder, and snapper are safer than river and lake varieties. When eating out, order your fish well cooked. Many upscale eateries lightly sear fresh fish on the outside and then serve it rare.

Keep in mind that in both the United States and Japan, many more people get sick from eating fish served at home than from eating fish at sushi restaurants.

Guidelines to cook fish

If you don’t have a thermometer, the guidelines listed below can help you to determine whether seafood is done.

  • Slip the point of a sharp knife into the flesh and pull aside. The edges should be opaque and the center slightly translucent with flakes beginning to separate.
  • Let the fish stand three to four minutes to finish cooking.
  • Shrimp and lobster turn red when cooked and the flesh becomes pearly opaque. Scallops appear milky white or opaque and firm.
  • For clams, mussels, and oysters, watch for the point at which their shells open, which indicates that they’re done. Throw out those that remain closed after cooking.
  • When microwaving seafood, rotate the dish several times to ensure even cooking. After letting the dish stand, check seafood in several spots with a thermometer to see if it’s reached the proper temperature.

According to the FDA’s 1997 Food Code, you should cook most seafood to an internal temperature of 145 degrees Fahrenheit (63 degrees Celsius) for 15 seconds.

Food safety, in general, is a concern for the pregnant woman and the fetus, as they might be more susceptible to some food-borne illnesses. The main three food-borne pathogens of concern for pregnant women include

  • Toxoplasma
  • Listeria monocytogenes
  • Salmonella enterica

These organisms can be passed to the fetus and increase the risk of spontaneous abortion, stillbirth, or perinatal complications. None of these organisms are a concern when eating sushi.

It is safe to eat raw fish (e.g. sushi and sashimi) in moderation, although women should choose low mercury fish, such as salmon and shrimp, over higher mercury varieties, such as fresh tuna.

In Japan, pregnant women do not generally stop eating sushi when they become pregnant, and many Japanese pregnancy books suggest eating sushi as part of a healthy, low-fat diet during pregnancy. Japanese tradition has it that postpartum women get certain kinds of sushi in the hospital during their recovery.

However, in the United States, pregnant women are scared away from sushi by being told that raw fish can contain harmful bacteria and parasites. These warnings, however, often fail to mention the specific bacteria and parasites that fish may contain, nor do they mention that fish prepared at sushi restaurants in the United States is usually flash-frozen by the distributors before it gets to the restaurant, and any parasites or bacteria in the fish is usually killed off during the process.

Mercury and fish

There are certain fish that pregnant women should not eat because of increased mercury levels (raw or cooked).

Fish that should be avoided during pregnancy because of mercury levels include:

  • Swordfish
  • Mackerel
  • Shark
  • Tilefish

Tropical fish poisoning

Tropical fish poisoning happens when a person eats fish (either cooked or raw) which contains certain toxins. The most common form of fish poisoning is Ciguatera poisoning which causes up to one million cases of fish poisoning a year. Ciguatera fish toxin is widely distributed throughout the Carribean and South Pacific. It is caused by eating fish raw or cooked which have ingested a microalga called Giambierdiscus toxicus. Persons poisoned with Ciguatera have nausea, vomiting, abdominal pain, and other symptoms within 2-6 hours after eating the poisoned fish and there is no specific treatment. Other fish toxins include scombroid, tetrodotoxin, and saxitoxin which are among the rarest and most poisonest of them.
Between the warnings about parasites in sushi as well as mercury and toxins in certain species of fish, pregnant women are being scared away from eating fish altogether. This is potentially harmful since the fatty acids in fish are the ideal nourishment for a developing baby.

Read more here on fish and pregnancy.

Benefits and risks of fish during pregnancy

Fish is good for you, it’s that simple. Not eating enough fish during pregnancy can have a negative effect on your baby’s brain development.

But what about all the warnings about fish? Can’t it make you sick? The National Academy of Sciences Institute of Medicine concluded in a 1991 report on illness from eating seafood: “Most seafood-associated illness is reported from consumers of raw bivalve mollusks…The majority of incidents are due to consumption of shellfish from fecally polluted water.”

If you take raw and partly cooked shellfish out of the equation, the risk of falling ill from eating seafood is 1 in 2 million servings, according to a government calculation from some years ago. By comparison, the risk from eating chicken is 1 in 25,000. Overall, 76 million cases of food poisoning are reported each year.

The main risk of illness from non-mollusks isn’t from eating them raw. Rather, as the Institute of Medicine reports, the problem is “cross-contamination of cooked by raw product,” which is “usually associated with time/temperature abuse.” In other words, no matter what you order in a restaurant, if it is not kept at a proper temperature and protected from contamination, you’re at risk.

Sushi is a typical Japanese food with over a thousand years of history and tradition. It actually began as a way of preserving fish. The raw, cleaned fish was pressed between rice and salt by a heavy stone for a few weeks. Then, a lighter cover was used and a few months later it was considered ready to eat. Not until the 18th century did a chef decide to serve sushi in its present form as fresh fish and forget about the fermentation process altogether.

  • Nigiri sushi is the traditional sushi which is a slice of fish (occasionally cooked) or shellfish pressed by hand onto a pad of cooked rice. Fish roe is also served as nigiri sushi in a style called gunkan, meaning “boat.” Nigiri sushi contains a hint of horseradish and is meant to be dipped in soy sauce. They are always served in pairs.
  • Maki sushi contains fish or other ingredients that are placed on rice and rolled with dried seaweed as an outer layer.
  • Sashimi is thin or thick slices of raw fish that are not served on top of individual rice rolls, but separately.
  • Temaki and Chirashi sushi are assorted raw fish and vegetables over rice
  • Chakin Sushi is vinegared rice wrapped in a thin egg crepe hand-rolled cones made from dried seaweed
  • Inari Sushi is vinegared rice and vegetables wrapped in a bag of fried tofu
  • Oshi Sushi is Osaka-style sushi: squares of pressed rice topped with vinegared/cooked fish
  • Oshinko are Japanese pickles
  • Wasabi is Japanese horseradish (it’s SPICY, watch out!

In the fishing and food industries, precautions are taken in the prevention of infected fish from getting into our food supply, but that is not a 100% guarantee. Food-borne illness is not limited to sushi or seafood but is a common concern of all food industries.

Between 1973 and 1987, shellfish accounted for 2.8% of the cases of food-borne illness reported to the Centers for Disease Control (CDC). These statistics may seem high at first glance, but they are somewhat misleading. For example, one in three cases of seafood-borne illness in the U.S. between 1977 and 1981 were attributed to ciguatera, a toxin found only in tropical and subtropical fish, and another 37% of the cases during the same time period were attributed to scombroid poisoning, a toxin produced in the flesh of some species of fish when improperly stored at high temperatures. Therefore, the statistics reported by the CDC are skewed by illnesses that either affect only a small geographical area or only occur with the mishandling of fish.

Uncooked meat or fish can potentially contain elements of worms or eggs, and the only way to fully kill worm eggs and other microorganisms is by fully and properly cooking fish and meats. Freezing fish will only kill mature parasitic worms. Illnesses that may develop from eating uncooked or undercooked fish or meats include hepatitis A, worms, parasites, viral intestinal disorders, and other diseases. In Japan there were a few reported cases of anisakidosis, a tiny worms in sushi that can cause gastrointestinal complications, but cases of anisakidosis are not commonly reported in the U.S. Pregnant or not, you should know that any time someone eats raw, uncooked, or improperly or inadequately cooked/handled seafood, there may be a problem.

Some have suggested that pregnant women should avoid any and all raw or undercooked meat, poultry, eggs and seafood (like sushi), as well as unpasteurized juice and milk, and soft cheeses, such as brie, feta and Camembert because these foods may contain bacteria that could be hazardous to you and your baby. But presently there are few cases of problems that justify generalizations.

If you want to be sure you won’t have a problem with raw fish, eat only well-cooked fish. You don’t have to completely give up on sushi and the safest way to enjoy sushi is to choose the fully cooked or vegetarian varieties, such as those that include cooked seafood. Here are some types of sushi that contain cooked or marinated fish or no fish at all:

  • Ebi: Cooked jumbo shrimp. Anago is a saltwater eel that is precooked and then grilled before serving.
  • Unagi: Fully cooked freshwater eel that is grilled and then brushed with a teriyaki-like sauce.
  • Kani: Real crab meat and is always served cooked, but is sometimes cooked then frozen.
  • Saba: Mackerel is always served after being salted and marinated for a few days, so in a sense, it is cooked.
  • California roll: Contains avocado and other vegetarian ingredients.
  • Kappa maki: Contains cucumbers.

Rest assured that overall, very few people in the United States get sick from eating sushi, and most infections occur from fish eaten at home, not from restaurants. You’re much more likely to buy contaminated fish at your local supermarket than get it at a good Japanese restaurant.

Fish, Mercury, and Pregnancy
Pregnancy Food Guide
Foods to Avoid During Pregnancy

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As we all know, pregnant women typically abstain from certain foods throughout their pregnancy — specifically, foods which could harm a growing fetus. Many types of fish, for example, have high levels of mercury — which can cause a liver infection in a pregnant woman — while others foods, such as soft cheeses, have long been on the “avoid” list but are actually quite safe.

Pregnant women are especially advised not to consume raw fish, due to the parasites that are naturally present in the fish and that could potentially cause a parasitic infection.

Carl Rosa, president of the Sushi Club of Houston, was recently asked by a pregnant woman if she could still eat sushi despite her doctor’s warnings. The answer is yes, and Rosa helped the woman create a list of sushi items she could eat — because none of them contain raw fish.

For all of the pregnant women who love sushi, here is Rosa’s list of sushi items you can eat while pregnant:

“When considering sushi, would-be moms merely need to avoid raw fish or seafood to avoid the rare and regrettable grasp of most food-borne parasites,” Rosa said. “And although raw fish is considered a hallmark of sushi, there are dozens of delicious options available for pregnant sushi lovers.”

Whenever you visit a sushi restaurant, simply ask your sushi chef or the manager to give you a list of cooked sushi options. You can still consume nigiri, vegetable rolls and fusion rolls.

If you enjoy nigiri such as these, Rosa suggests trying shiitake nigiri or boiled king crab leg nigiri. Avocado rolls and cucumber rolls are excellent vegetable-only sushi rolls, while caterpillar rolls, spider rolls and California rolls are also wonderful fusion roll choices. Rosa advises, however, to always ask your sushi chef or restaurant manager, as they will know the food best and will be able to provide safe sushi choices.

Rosa worked with Kubo’s Sushi Bar & Grill, Kata Robata, Zushi and Redfish Seafood Grill to create a list of rolls and other sushi options pregnant women can consume. As a result, each of these restaurants has special rolls and sushi that are safe recommendations for pregnant women.

Kubo’s Sushi Bar & Grill

Try the Kubo’s Roll (fried shrimp and spicy mayo) or the Alaskan King Crab Roll with king crab, asparagus and avocado. But remember to ask your chef to make both of these without tobiko, which are fish eggs.

Kata Robata

Kata Robata offers the Longhorn Roll with fried shrimp, freshwater eel, avocado, spicy mayo and a sweetened unagi sauce. Remember to ask your sushi chef to not include those fish eggs.

Zushi

Order the Jack William Roll at Zushi for a safe sushi roll filled with tempura vegetables, avocado and snow crab. It’s topped with peppered rib eye, leeks and a citrus soy sauce.

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Redfish Seafood Grill

For a pregnancy-safe roll, try the Happy Roll, which includes tempura shrimp, masago, jalapeño, cream cheese, mayo and an avocado, kani and seaweed salad topping. Again, ask for the chef to remove the masago.

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  • Pot Luck

Really? No lunch meat or sushi during pregnancy, and I can’t touch kitty litter??

There are TONS of rules about what you should – and shouldn’t – be doing during your pregnancy. Perhaps you’ve already been admonished by an annoying coworker for eating sushi, or received an unwanted lecture from some stranger in the grocery store about the dangers lurking inside a turkey sandwich.

The truth of the matter is that the majority of miscarriages, stillbirths, and birth defects occur for reasons that are totally outside of your control. This will either give you comfort or totally freak you out; hopefully it’s the former.

As it turns out, many of the pregnancy police rules come not from actual data or studies, but from the “why-take-a-chance” philosophy that pervades American medicine, no matter how infinitesimal the actual risk. (Why not install a meteorite-guard on your house???…)

First, a biology lesson.

Mr. (or Ms.) Fetus

For moms carrying your own egg, only half of your tiny peanut is identical to your own biology (the other half belonging to your inseminator — otherwise known as your husband, boyfriend, guy at the bar that night, or, actual sperm donor).

Because of this dissimilarity, your little ball of baby cells would normally be rejected by your body’s own immune system (much like with a transplanted organ). Thankfully, our immune systems have evolved to know NOT to attack the developing fetus.

Essentially, your whole immune system lets down its guard for the duration of your pregnancy. As a result, pregnant women are more vulnerable to nasty stuff. This helps explain why you’ll get every strain of cold under the moon during the 3rd trimester, even if you are normally quite healthy.

So, which of the rules are justifiable and which aren’t? Let’s have a look.

Listeria Hysteria

Listeria is the big bad bacteria that you want to avoid during pregnancy, mainly because it can cross the placental barrier and infect the fetus, which can result in miscarriage or fetal death.

True, pregnant women are about 20 times more likely to get listeria than non-pregnant women, but EVEN SO, it is EXTREMELY rare, infecting only about 1 in 8,000 pregnancies per year.

For the sake of comparison, your lifetime chance of dying in a car accident is about 1 in 500.

It should also be noted that most listeria infections in pregnancy occur in the 3rd trimester, when suppression of Th1-mediated immunity is at its maximum.

The highest-risk foods for listeria are preserved fish (lox and stuff), cheese from unpasteurized milk, deli meats, pâté (pa-TAAAAAY), and undercooked hot dogs. Stuff like that.

But here’s the thing — any food that’s been indicted for carrying a possible listeria contamination in the last 20+ years seems to automatically get added to the “no-no” list. Celery, turkey, carrots, cantaloupe, etc. This doesn’t make any sense. Just because last year, packaged spinach was the culprit doesn’t tell you anything about a possible contamination this season, because it’s totally unpredictable. Some even suggest that eating a food (a particular soft cheese, say) that was associated with a previous listeria outbreak is actually safer because it’s statistically unlikely it would be contaminated yet again (not to mention, safety regulations).

Bottom line: With those kinds of odds, you should worry more about your driving than your turkey sandwich.

Sushi During Pregnancy

Most American OBs say, “No sushi for you!” However, if you look at the data, 85% of seafood illness comes from eating raw shellfish – that’s right, bivalve mollusks, namely, raw oysters and clams.

If you remove those foods from the equation, the risk of falling ill from eating seafood is 1 in 2 million servings. So…can we agree that we won’t eat raw oysters and clams? I mean, really? Millions of Japanese women are not wrong (and yes, with some of the best public health officials in the world, they’ve looked into it).

Furthermore, fish eaten in a sushi restaurant in the US is almost always flash frozen before it gets to the restaurant, so any parasites or bacteria in the fish would have been killed during the process.

Bottom line: No raw shellfish, but your salmon roll shouldn’t be any more scary than your chicken sandwich.

Freddy Mercury

“You should eat lots of fish when you’re pregnant.” No wait… “You should avoid fish when you’re pregnant.”

Well, which is it?

“Between the warnings about parasites in sushi and about mercury in certain species of fish, pregnant women are being scared off fish altogether. And that’s bad news, since the fatty acids in fish are the ideal nourishment for a developing baby,” said Steven Shaw, a former food writer for The New York Times.

Furthermore, researchers found that greater maternal intake of omega-3 fatty acids in fish was associated with better fine motor development, more pro-social behavior, and better social development. (This is why you hear so much about DHA in pregnancy.)

So is there a “too much”? All researchers can do is guess at it, but many suggest that the warnings against seafood consumption are dramatically overblown.

In fact, a study in the Seychelles (a high fish-eating population) showed no link between children’s development over their first six years and the levels of mercury contained in their mothers’ hair during pregnancy, which is a measure of the amounts to which fetuses were exposed. More recent studies have reached similar conclusions. Economist and expert Emily Oster wrote about this in her book Expecting Better, and she said that if even the most mercury-ridden mother totally dropped her mercury exposure to 0 for her entire pregnancy, the end result would probably be, on average, that her child would receive roughly a 1 point boost in her IQ. Big whoop.

That said, avoiding the high-mercury fish seems like a reasonable course of action. And eating low-mercury seafood as much as you can is a fantastic idea. The EPA and the FDA made a handy-dandy chart:

Bottom line: Common sense would tell us to limit consumption of fish that are high in mercury, such as shark, swordfish, king mackerel, tuna, and tilefish (sorry, no shark for you this week ).

The Truth About Kitty Litter

Toxoplasma gondii is a parasite whose only natural host is the cat. Reeeer.

The truth is, if you’ve had an indoor/outdoor cat for years, your chances of being immune from a previous exposure are fairly high – perhaps as high as 90%.

Studies show… only about 1 in 1,500 pregnancies (0.06%) are actually affected by congenital toxoplasmosis (when the fetus is infected with the parasite). And, it’s actually more likely to stem from under-washed fruits/veggies or undercooked meat. So you’re more likely to prevent toxoplasmosis from washing your produce well and making sure you cook your meat thoroughly than avoiding the litter box.

Should you tell your husband or partner that this really isn’t a threat after all?

Hell-to-tha-NO! Let him think it’s highly lethal for, like… the rest of your life (come on, you can’t get drunk for the next few months, the least they can do is scoop some kitty crap, yeah?). It’ll be our little secret. 😉

Conclusion: Ladies, I’m not saying you can’t get sick from things like listeria, sushi, and kitty litter. I’m just saying it’s fairly unlikely (k, so don’t sue me). The beauty is that everyone can decide based on their own risk tolerance. I love ‘dis country!

Related

  • Make your non-maternity pants last longer with Bellaband.
  • Creating a registry? Check out Amazon for quick, easy baby registry. You can easily access your registry using their mobile app. Plus, 10-15% “registry completion” discount .
  • Registry cheat sheet, for reference
  • Did you miss? Great Pregnancy Books.

Eating sushi when pregnant

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