Pizza can be a pregnancy minefield. It typically contains many of the ingredients that are often harder to check. Is pizza cheese pregnancy safe? Can you eat it cold? What about if it’s got pepperoni on it? I’ve attempted to answer all these questions (and more) in this guide.
Is pizza safe in pregnancy? Pizza can be safe to eat when you’re pregnant, but there are several things to check first. Meat toppings like pepperoni need to be heated until steaming hot, and any cheese should be made with pasteurized milk. There are also other considerations when eating pizza in pregnancy.
This article deals with the toppings first, including some you may have to avoid in pregnancy. Then I’ve dug into which restaurant chains you can or can’t get safe pizza from, and whether or not you can eat pizza if it’s cold, burned and so on. In short, this will hopefully be everything you have ever wondered about pizza if you’re pregnant.
I ought to start by saying that pizza itself is safe in pregnancy – the gray areas are always surrounding the toppings, not the base itself. A yeast-dough pizza base topped with tomato sauce and herbs is safe in pregnancy. This makes it preferable to make your own if you just want to start with a base and add toppings that you know are safe when you’re pregnant.
Pregnancy-safe (and unsafe) pizza toppings
Here, I’ve broken down many of the components of popular pizzas with respect to their safety in pregnancy:
Pizza Cheese in Pregnancy
Pizza cheese is usually mozzarella, which is safe for pregnant women if it’s made from pasteurized milk. Almost all commercially-made mozzarella is made with pasteurized milk, including popular brands such as Galbani, Kraft and all supermarket own-label mozzarella. This makes it safe to put on a pizza if you’re pregnant.
Other cheeses often found on pizzas may not be safe in pregnancy. These include:
- Any unpasteurized or soft cheese such as brie
- Ricotta (if made with unpasteurized milk)
- Soft, blue-veined cheeses like gorgonzola
- Soft goat cheese (chevre)
Soft, mold-ripened cheeses carry the risk of listeria, so should be avoided by pregnant women. This includes when they’re put on a pizza topping towards the end of cooking, so they are merely warmed up. Warming the cheese will not remove the risk of listeria.
However, cooking the cheese on top of the pizza until it’s very hot, not just warm, makes it safer in pregnancy, even if it’s normally out-of-bounds. for example, if you had a blue cheese and bacon pizza, and both the cheese and the bacon were heated to a high temperature (until both are sizzling), this would render it safe for pregnant women to consume. Some people don’t like these types of cheeses when they’re heated up so much (after all, they’re not meant to be eaten this way), but heating the cheese kills any potential listeria contamination.
Processed or Cured Meat Pizza Toppings When You’re Pregnant
Extra caution should be taken if you want to eat a meat-topped pizza when you’re pregnant. Deli, processed or cured, uncooked meats on a pizza may include:
- Ham pieces
- Sausage or ground beef or pork
If you’re pregnant and want to eat a pepperoni pizza or any other pizza with similar meat toppings, you should ensure that the meat topping is cooked until steaming hot (and not just warmed).
This is usually the case if the pizza is freshly made – you can see the pepperoni or salami bubbling and starting to crisp around the edges. When heated to this temperature, the risk of listeria contamination is vastly reduced and the pepperoni pizza is safe to eat, even when pregnant.
What you have to look out for are toppings that are normally NOT heated up with the pizza. For example, you may order prosciutto topped pizza where the prosciutto is sprinkled over the pizza prior to serving it, rather than going in the oven with the rest of the ingredients. This is where you’ll have to request that the ham, prosciutto or other similar meat is cooked in the oven until steaming hot before eating it.
Uncured, cold meats aren’t safe in pregnancy due to the risk of listeria contamination, which is only eliminated by heating the meat up to 165f / 75c, or ‘steaming hot’. A domestic or commercial pizza oven will easily reach this temperature.
Eating Fruit and Veg on Pizzas When You’re Pregnant
If you’re going to eat pizza during pregnancy then it’s always a good idea to try and up your veggie intake, since pizza is not a particularly healthy food, as discussed later in this article.
The only caution regarding vegetables in pregnancy is if you’re eating them raw or undercooked, and if they haven’t been washed or prepped properly (resulting in the potential for toxoplasma or listeria to remain on them). Fruit and veg on a pizza should always be cooked thoroughly.
Like the meat and other pizza toppings, the high temperatures of a pizza or domestic oven will kill any dangerous bacteria and make a vegetable pizza safe for pregnant women.
Fruit isn’t often found on pizza but you may also wonder if it’s safe to eat a ham and pineapple pizza (otherwise known as a Hawaiian). Ham and pineapple pizza happens to be my favorite topping (controversial, I know) and is perfectly safe in pregnancy if the ham and pineapple are both cooked until steaming hot.
Pineapple has many myths surrounding its safety for pregnant women because it contains the enzyme bromelain, which pregnant women should avoid in tablet form. However, fresh pineapple doesn’t contain enough bromelain to have any significant effect, so pineapple is safe to eat on a pizza if you’re pregnant – just ensure it’s heated up until it’s hot, along with the meat or ham.
Mushrooms are safe to eat on a pizza if you’re pregnant – if they’re fully cooked and not raw. Other veg, especially leafy veg like spinach, must also be cooked thoroughly and not sprinkled on top in their raw, leafy form. Raw greens can be contaminated with listeria, and heating them up will kill any microbes and sufficiently reduce the risk.
Eating “Breakfast Pizza” or Pizzas with Egg in Pregnancy
Some pizzas have a raw egg cracked on to them and are subsequently served with the egg white cooked, but the yolk can still be runny. This occurs on ‘breakfast pizzas’ and also some Italian-style ‘Carbonara’ pizzas or similar.
Be aware of this if you’re eating one when you’re pregnant because runny egg yolks should be avoided in pregnancy. This is due to the potential presence of salmonella in undercooked, unpasteurized eggs. Ask if the egg is pasteurized, and if it isn’t, ask for it to be cooked through until opaque – including the yolk.
Eating Restaurant or Take-Out Pizza in Pregnancy
Many pregnant women wonder if it’s still OK to eat pizza if it’s from a restaurant or take-out store. I’ve covered the most popular pizza chains below, from an ingredient standpoint, followed by advice on what to do when you’re eating pizza take-out, delivery or in a restaurant.
- Domino’s Pizza uses pasteurized cheese on their pizzas, as confirmed on their official website. This includes the provolone, mozzarella, and parmesan they use. Other items like dressings and sauces are also made with pasteurized ingredients.
- Pizza Hut also uses pasteurized ingredients both in their restaurants and for carry-out. This applies to all cheese, dipping sauces and dressings. This is confirmed on their nutritional information on their official site.
- Papa John’s use pasteurized ingredients on their pizzas, including the mozzarella. This is confirmed on their official website. The dippings sauces, even though they contain egg yolk, are safe for pregnant women as they’re pasteurized as well.
- Little Caesar’s also use pasteurized ingredients in their cheese. Of all the chains, I’d say their pizzas tend to be on the ‘just done’ side, which is fine normally, but ask for them to cook yours for a little extra time.
- Pizza Express confirms on their website that they use cheese that is made with pasteurized milk, so it is safe in pregnancy. All other advice about meat (and eggs) still apply. As Pizza Express makes pizzas fresh to order you can specify that you’re pregnant and want to avoid particular ingredients (or have them cooked longer).
- In all other restaurants, it’s best to ask first whether they use pasteurized ingredients. You can also follow the guidelines on this page to ensure your chosen topping is pregnancy-safe.
In all restaurants and take-outs, be aware that the pizza must be heated until steaming hot before you eat it. If the delivery takes a while, the pizza may only be warm and not hot, and you won’t know what temperature it started out at. To be on the safe side, zap a delivery or restaurant pizza in the microwave for 30-60 seconds (depending on your microwave’s power) until the topping is sizzling/steaming. Or put it under the grill or broiler for a few minutes.
Some pizza chains cook their pizzas more than others. A thin, wood or coal-fired pizza is more likely to have been cooked at higher temperatures than a deep-pan one placed in a commercial oven. Whether at a restaurant or takeaway, ask for a freshly cooked pizza, possibly more ‘well done’ than they usually serve it, to ensure the topping is cooked thoroughly.
Can Pregnant Women Eat Cold, Leftover or Reheated Pizza?
If you’ve ordered too much from the takeaway or there are leftovers from a family dinner, you might wonder if you can still eat that leftover pizza if you reheat it. First, ensure it’s stored properly – left to cool and then wrapped in the refrigerator.
You can eat reheated pizza in pregnancy if it’s cooked to that same sizzling or steaming hot temperature during the reheating process. A microwave, oven or grill/broiler will do this. If you’re able to, check that the internal temperature reaches 165F / 75c as most bacteria are killed at this temperature. Eat the pizza within a day or two – don’t leave it for much longer in the fridge, as this gives bacteria time to multiply.
Eating cold pizza in pregnancy isn’t recommended. That’s not to say that you’ll definitely get sick, but bacteria can begin to multiply quickly on cold, lukewarm or room temperature pizza. The risks are low if the pizza was thoroughly cooked the first time around, but it’s much safer to eat it hot.
Can I Eat Undercooked or Burned Pizza in Pregnancy?
Burned pizza, besides tasting bitter (unless you like it that way) is safe to eat in small amounts pregnancy if the pizza is cooked thoroughly (presumably, it is, if it’s burned!) Note that some people think that pizza is ‘burned’ when it’s cooked in a coal-fired or wood-fired oven and has charred bits around the edge. That’s not really ‘burned’, just charred, and is the way it should be.
If the pizza is significantly blackened, including the topping, it’s better not to eat it. This is because burned foods are higher in acrylamide, a toxin that has been found to cause cancer in animals in very high doses (source: FDA). Eating small amounts of burned pizza (or other foods) is unlikely to be harmful. However, it’s probably best to avoid very-burned pizza slices, not just because of the presence of acrylamide, but because it’s also likely to give you heartburn and/or indigestion, both of which are more common in pregnancy.
Undercooked pizza should be avoided in pregnancy as it won’t have reached temperatures high enough to kill any bacteria such as listeria or toxoplasma, both of which may be present in common foods used to top pizzas, such as meat or veg.
Always ensure that a pizza is well cooked, to an internal temperature of 165F or 75C. The very center of the pizza is the most likely area to be undercooked, so check this first.
Can Pregnant Women Eat Frozen Pizza?
Frozen pizza is safe in pregnancy if it’s thoroughly cooked first. The fact that it’s been previously frozen has little impact on the safety of the pizza, other than the fact that bacteria are less likely to survive in freezing temperatures – but this also depends on how long it’s been frozen for, and at what temperature.
To eat frozen pizza safely in pregnancy, follow the cooking directions for the particular brand and ensure the pizza is cooked until the toppings are steaming hot or sizzling, especially in the center. Frozen pizza can often look done on the edges and still be only warm in the center.
All commercially-made frozen pizzas will have used cheese made from pasteurized milk. If the frozen pizza in question is homemade or similar, ensure it’s cooked until very hot.
Can You Eat A Calzone or Pizza Roll if You’re Pregnant?
Calzone is safe in pregnancy if the interior reaches a temperature of at least 165F (75C). Unlike traditional open-top pizzas, the only issue with a calzone is the fact you can’t see the topping, so you cannot gauge whether it’s sizzling or steaming hot inside. If you’re cooking or eating a calzone, either cook it for extra time or ask the restaurant to do the same.
The same goes for pizza rolls or any pizza style foods where it’s not easy to tell what temperature the meat and veg have reached. It should be steaming hot when you cut into it, and not just warm.
Can I Eat Pizza in the 1st Trimester?
Pregnant women can safely eat pizza in the first trimester or at any other time during pregnancy, so long as the guidelines here are followed about it being fully cooked, especially if it contains meat or veg. The ingredients on a pizza only become potentially unsafe if the pizza is merely warm and not hot.
Is Eating Pizza In Pregnancy Healthy?
Pizza is one of the most-craved foods by pregnant women. It’s convenient and tasty, but unfortunately, it’s usually laden with calories, salt, and fat and isn’t particularly healthy. Restaurant pizza can clock in at over 300 calories per slice and can be even more if you’re opting for a deep-pan or stuffed crust version. Serving sizes are usually far above the recommended level, too. High fat, high-carb food isn’t recommended in pregnancy so pizza should only be enjoyed in moderation.
That said, if you’re craving pizza then there are ways to make it more healthy, especially if you make it at home. Some tips are:
- Use less cheese – since mozzarella melts so widely, it’s easy to use less of it and still cover a pizza
- Opt for thin bases rather than thick, deep-pans or stuffed crusts
- If making your own, put pizza topping on a healthier wrap or tortilla, rather than a dough base
- The dipping sauces are intended to make you eat even more, so try to curb them. Act like a kid and leave the crusts!
- Load up with roasted veg on the pizza rather than opting for toppings heavy on meat or cheese
- If you’re eating out, a kid’s portion can satisfy a craving whilst still reducing your calorie and fat intake
- If you’re eating an oily pizza (for example, oil that has leeched from pepperoni), blot it off with a kitchen towel instead of eating it
- Eat a slice instead of a whole pizza and pair it with a home-made salad instead.
If you really want it, don’t deny yourself a slice of pizza, but being mindful of ingredients and cooking temperatures will make sure it’s safe in pregnancy.