Early pregnancy can be a heady mixture of joy and anxiety. In the earliest weeks and months of pregnancy, new mothers-to-be are particularly concerned that they do everything ‘right’ and avoid eating any food that could be potentially harmful to their baby. Many of these foods should be avoided throughout your entire pregnancy, not just in the first months or trimester.
The good news is that there are very few foods that are a total no-no in pregnancy, and these are listed here. These are the foods that could be either directly harmful to your baby’s growth and development, or carry a high risk of passing along serious illnesses or infections to mother or baby, or both. They’re particularly important in the earliest stages of pregnancy when the risk of miscarriage is higher.
This article covers food, and not drink. If you’re wondering about what is ‘safe’ to drink in pregnancy then you may enjoy this other article I wrote on the top ten drinks pregnant women can enjoy besides water. For now, though, let’s address the food:
1. Pre-Prepared or Pre-Packaged Salad or Veg
In early pregnancy, you should eat nutrient-dense food, and you can get many micronutrients from veg and salad. However, caution should be exercised if you’re using pre-prepared or pre-packaged bagged salad or fruit as this may contain either listeria or salmonella, even if under refrigeration.
Both listeria and salmonella pose significant risks to pregnant women. Both types of bacteria grow in salad bags (even sealed ones). The National Health Service (NHS) in the UK quoted a 2016 study where it was found that leaves that had broken or were leaking ‘juice’ were susceptible to salmonella contamination when still in the bag.
The NHS also pointed out that bagged salads are the second most common cause of foodborne illness. The risk is similar in the USA, where there have been frequent product recalls due to the presence of listeria discovered in pre-packaged salad, veg, and fruit. The CDC (Centers for Disease Control and Prevention) has a list of current recalls (you can view it here), and many past outbreaks have been caused by pre-packaged salad, veg or fruit.
Women in the first months of pregnancy should only eat salad they have prepared and washed thoroughly themselves (see further down this list about the risks of unwashed fruit and veg). Contamination with listeria or salmonella is rare, but you can lower your risk by avoiding:
- Salad bars – these are susceptible to cross-contamination and the food contained in them is frequently pre-prepared or packaged
- Eating salads in restaurants or other places when you eat out, including in sandwiches etc., since you have no control over how each individual item in the salad has been prepped, washed or stored
- Eating bagged, pre-packaged or pre-prepared salad, veg or fruit, even if it’s under refrigeration and still sealed, as listeria can still grow under these conditions
If you want the convenience of bagged salad, you could opt to wash it thoroughly yourself when you buy it, and eat it straight away rather than storing it in the fridge. Some pregnant women prefer to do this as a balance between risk and convenience, and some avoid bagged or pre-packaged salads altogether. Remember, the risk of contamination in bagged salads is low, at around 0.1% (source: NPR). In salad bars and other open-air choices, it may be higher.
2. Foods High in Vitamin A
It ought to be emphasized that pregnant women do need vitamin A to help their growing baby’s development – it’s only an excess of it that can be a problem. Vitamin A comes in two forms, retinol (also known as preformed vitamin A) and provitamin A carotenoids, which are converted into retinol in the body.
Vitamin A is measured in Retinol Activity Equivalents (RAE), and as a rough guide, most pregnant women require around 750 micrograms per day depending on their age (consult your health practitioner about the quantities of vitamins and minerals you’ll personally need in your pregnancy).
What is common to all pregnancies, however, is that you shouldn’t eat food that is very high in preformed vitamin A (retinol) as excess amounts can cause birth defects and build up to toxic amounts in the liver. You can get enough vitamin A from a healthy diet, including many veggies such as sweet potatoes, squash, spinach, greens and some types of fortified milk. The following foods should be avoided as they’re exceptionally high in vitamin A:
- Beef or lamb liver (all animal livers, to an extent, are high in vitamin A but these two are the highest)
- Pâté – this usually contains a high amount of liver, however, you should avoid eating pâté in pregnancy (see below) anyway, as it also carries the risk of listeria contamination
- Liver products such as liver sausage (liverwurst) or stews containing liver
- Cod Liver (oil, supplements, etc.) as this is also a liver product high in Vitamin A.
3. Unpasteurized Dairy, Milk, Juice & Soft Cheeses
Pasteurization is a way of heat-treating food and drink so that it kills bacteria such as Listeria monocytogenes, which leads to listeriosis. Listeriosis is a rare but serious foodborne illness that pregnant women are more susceptible to and causes serious complications in pregnancy, as well as miscarriages (source: Reviews in Obstetrics & Gynecology). It is imperative that pregnant women avoid unpasteurized food not just in early pregnancy, but throughout the time they are pregnant.
It can be difficult to tell which foods are unpasteurized or not and this is further complicated by the food administrative body of which country you’re in. In the USA, pasteurization of cheese, milk, and juice is the norm, but some specialist products and imports may still contain unpasteurized ingredients. In Europe, it’s more common to find unpasteurized products, particularly cheese. Raw milk is available in many countries but it’s usually advertised as such.
As a general guide: usually, food that is unpasteurized will state that it is clearly on the label. In the USA, about 5% of fruit juices are unpasteurized but they have to state this clearly on the packaging. Commercially processed milk and cream are often pasteurized as standard. In the UK, many French cheeses and some milk is unpasteurized and you should check on a case-by-case basis.
Soft Cheeses (including blue-veined ones like gorgonzola) are more likely to contain listeria than hard cheese as they contain more water – an environment where listeria can grow, even in a fridge. Therefore even if a soft cheese (such as brie and other mold-ripened examples) is pasteurized, it should also be avoided in pregnancy.
Pregnancy Food Checker has many articles on which products and brands are pasteurized or not, including cheese, ice cream and many more examples including where to buy them or source them. You can search for any particular food type from the top right of our homepage.
4. Raw or Undercooked Meat, Fish, Eggs or Veg
We eat raw or undercooked food more often than you think: sushi, rare steaks, poached eggs with runny yolks, pre-packaged carrot sticks… when you start to think about it, there are many foods you’ll have to think about and avoid. The risks associated with each type are:
- Raw meat and fish (including sushi, tartare, and steak with any pink in the middle) may contain toxoplasmosis parasites. This is an infection that is rare but can be very harmful to you and your baby.
- Runny or undercooked eggs (including “sunny side up” eggs, poached or soft-boiled) should be avoided due to the potential presence of salmonella. The advice in the UK differs slightly because if the egg has a ‘Lion Mark’ it is deemed to be safe to eat runny. For all other countries, though (and the UK eggs without a Lion Mark), the same advice to avoid runny eggs applies. Bear in mind that some foods may contain raw egg without you realizing it, such as hollandaise sauce, mayonnaise or mousse style desserts. Always check the ingredients first.
- Raw or undercooked veg – if unwashed. This is covered more in detail below and has already been mentioned under ‘pre-prepared salad’, but you should only eat raw veg if it’s been thoroughly washed and prepared yourself.
5. Pate or meat spreads
Pate shouldn’t be eaten at any stage or trimester of pregnancy for two reasons:
- Meat pate is almost always made with liver, which is excessively high in vitamin A. Too much vitamin A is harmful, as mentioned above.
- Even if the pate is vegetarian, it should still not be eaten because of the way it’s made and the possible presence of listeria.
The above refers to pate and spreads that are ‘fresh’ and refrigerated. Pate in a jar at a shelf-stable (non-refrigerated) temperature has usually been pasteurized and is therefore safe, but check the label first, and avoid any containing liver, shelf-stable or not.
6. Cold or Undercooked Ham, Deli Meat, Salami or Processed Meat
Listeria is one of the few types of bacteria that can multiply in cold conditions, such as under refrigeration. This makes some types of food particularly susceptible to contamination, including deli and processed meats.
“Deli meat” and “sandwich meat” are broad descriptions, however, this usually refers to any meat that is usually served cold such as the type you buy ready-sliced or packaged, cooked and cold, that appears frequently in sandwiches, or that is carved off a joint for you behind a deli counter.
The safety advice differs depending on which country you’re in. In the UK, women are assured that they can eat pre-packaged meats (e.g. sandwich ham slices, the kind you buy in a supermarket) (Source: NHS). In the USA, women are advised to avoid all cold, cooked meat (source: American Pregnancy Association). In all countries, women should avoid any meat that is raw and cured, rather than cooked, such as parma ham.
Heating food until it’s steaming hot kills listeria, so this is the only safe way for pregnant women to consume deli meats, salami, and processed meat. If you’re going to eat deli meat or processed meat then heat it until it’s steaming hot. This is usually easiest done by putting it in the microwave for 30-60 seconds depending on the power of your microwave.
If heated-up deli meat doesn’t sound appealing then you could always treat it like a hot sandwich, a ‘toastie’ or a panini. Ensure any salad you put in the sandwich is fully washed, the meat is steaming hot, and you’ll be lowering the risk of listeriosis.
7. Improperly Washed Produce and Raw Sprouts
Listeria is present in both water and soil, and toxoplasma gondii (the cause of toxoplasmosis) is also present in soil, so it’s imperative to wash any fruit or vegetables that grow in or near soil. This applies even if you can’t see any visible dirt on the produce itself, and even if it’s been pre-washed (such as a bag of potatoes). Bacteria can also be present on the skins and rinds of fruit and vegetables, even if they look clean.
You may opt to peel your fruit and veg, then wash it, before eating it, or to wash fruits before juicing or squeezing them. Use a vegetable brush, cut away any bad parts and use a veggie wash rather than soap or bleach.
The potential presence of both listeria and toxoplasma in fruit and veg is why it’s important to be aware when eating out – if you haven’t seen the fruit or veg prepared, peeled and washed yourself, you’re essentially relying on the hygiene practices of the establishment you’re eating at. Naturally, many places do have high standards of cleanliness and sanitation but this is not guaranteed in every establishment.
Raw sprouts (such as those eaten in a salad) may contain bacteria that can get into the shell or seed of a sprout before it grows, causing contamination even if they are grown in sanitary conditions. The FDA advises that pregnant women avoid raw sprouts altogether as they have been responsible for several outbreaks of foodborne illness. If you want to eat sprouts, cook them thoroughly and fully.
The gray areas surrounding fruit and veg are why it’s generally advised that pregnant women prepare their own salad, fruit, and vegetables at home.
8. Food Containing Caffeine
You don’t just have to limit your caffeine intake from drinks in pregnancy, but from food as well. Many people aren’t aware that caffeine is present in many foods, notably:
- Chocolate naturally contains caffeine, present in cocoa beans. As a general rule, the darker the chocolate, the more caffeine it can contain. An average dark chocolate bar contains 25mg and a milk chocolate bar is closer to 10-15mg. Bear this in mind if you’re making hot chocolate or chocolate milk with cocoa, too.
- Coffee flavored ice cream or desserts – many coffee flavored sweet treats will contain caffeine if they have coffee in them, but it’s usually in trace amounts that you needn’t be concerned by. However, coffee beans themselves are sometimes used in recipes or for decoration, and these do contain about 10mg per bean. Also, some desserts call for espresso coffee either poured over or soaked in the ingredients (like tiramisu) so they will contain more caffeine than usual.
- Green tea ice cream, mochi or other desserts will have to be checked for caffeine content contained in the tea. Some green tea ice cream is made with sencha powder, upping the caffeine to 20-30mg per serving. Check the label or with the manufacturer to see if the caffeine content is significant.
9. Soft Serve Ice Cream, Milkshakes or Desserts
Ice cream and other desserts are a common craving in pregnancy, so it comes as a bit of a shock (and disappointment!) that there may be issues eating soft-serve ice cream or frozen yogurt (or drinks made with them) in pregnancy.
Many pregnant women presume that this is a pasteurization issue but that’s not the sole cause of concern. The mix that goes into soft serve machines, including ones that make milkshakes, is usually made from pasteurized milk and cream. This should be checked first, but the main complication actually stems from the machine itself rather than the contents.
As I’ve mentioned several times so far in this article, listeria is the culprit here – it can thrive in dark, cold, damp conditions. Soft serve machines are therefore a perfect environment for listeria to thrive – but only if the machines are not cleaned properly.
Listeria outbreaks from unhygienic machines are very rare, but they do happen, such as this 2015 incident where milkshakes were contaminated. Almost all businesses in the food industry that operate a soft-serve machine have strict procedures in place to ensure thorough and regular cleaning and sanitizing of their machinery.
Eating soft serve comes down to personal choice and common sense. If a store or restaurant appears unhygienic in any way, then it’s probably not a good idea to eat there. That said, considering that the above outbreak happened in a hospital, sometimes you just can’t tell how clean the machine is on the inside. You’re trusting the last staff member whose job it is to clean the machine thoroughly. For this reason, many women avoid eating soft-serve ice cream yogurt and products (like milkshakes) made from the same type of machine.
10. Fish Species High in Mercury
Methylmercury is a neurotoxin that is harmful to fetal brain development. It can be present in lakes, rivers, the sea and other environments where fish are caught for human consumption. The higher up the food chain the fish is, the more concentrated the levels of methylmercury will be.
Pregnant women should avoid these fish in order to prevent a build-up of methylmercury in their bodies. The fish species that are usually highest in mercury are king mackerel, orange roughy, swordfish, tilefish, shark, marlin and many types of tuna. including ahi and bigeye.
Since tuna is one of the most commonly eaten fishes in the USA and UK, this is the fish that pregnant women find themselves having to avoid more often. You can eat tuna in pregnancy (and it has benefits such as being high in protein and omega-3 fatty acids), but you will have to both keep an eye on which species it is, and limit your consumption. If you have a choice of species, skipjack tuna is the least high in mercury.
As a general rule, don’t eat tuna more than a couple of times a week. Stick to ‘light’ tuna varieties and choose skipjack over albacore. Skipjack is more common in the UK and albacore is more common in the USA when people refer to just “tuna”. It doesn’t matter whether the tuna is canned or fresh, it’s the quantity you’ll have to keep an eye on. One serving of tuna should be about 3.5oz (half a cup, or 100g) so check the size of the can, pouch or steak as they can contain several servings.
Help! I Accidentally Ate Food I Shouldn’t Have When I’m Pregnant
The first thing is not to panic. I’ve heard countless stories of women who accidentally ate a mousse with raw egg, ate a big tuna sandwich, had a soft-serve ice cream cone, or ate salad in a restaurant and spent days in a stew of anxiety, worry, and guilt.
Consuming any item on this list is not, in itself, going to necessarily cause definite problems in pregnancy or harm your baby. As a pregnant mother, you are not statistically more likely to get food that is contaminated, it’s that when you do, it is potentially more harmful. Bearing this in mind, the odds of contracting any foodborne illness are still very low. You should:
- Try not to panic or feel guilty – additional stress and worry are not good for either you or your baby. Try to remember that statistically, you are unlikely to get sick from a one-off meal.
- If you have had one incidence of eating too much of one thing (e.g. tuna) or have gone over the guidelines, it is unlikely to be harmful – avoid continuing to eat anything that may be harmful in large amounts.
- Monitor your symptoms carefully for the next few days – this can be difficult as many of the symptoms experienced in pregnancy such as nausea or headaches can also be caused by food poisoning.
- If you feel unwell – even if you think it’s just morning sickness or other more ‘normal’ causes, consult a health professional straight away. Let them know what you ate, and when.
- Bear in mind that some illnesses don’t have many symptoms but can still be harmful to a developing baby. If you have any concerns about what you have eaten or suspect that you may have a foodborne illness, consult a health professional without delay.