Why Are These Foods Off-Limits During Pregnancy?
Why Mothers of Kids under 5 and Older Folks Should Take Note
A Food Safety Refresher for Everyone
Pregnancy can be hard time to enjoy food when navigating nine months of swings between queasiness and cravings. Doctors hand expectant couples a list of no-go foods and suddenly you’re longing for the days you could have chosen sushi for dinner. Relatives will want to weigh in on the glasses of wine they drank and the Sunday bagel and lox brunches they ate back in the ’70's …”and look how my Andrew turned out” …before these prohibitions became pregnancy guidelines.
There are simply some foods that are best avoided for the safety of mothers and babies. It’s worth understanding why the guidelines evolved and to stick to them to ensure a healthy pregnancy. Children under five are also more vulnerable to serious cases of bacterial illness from food while their immune systems are developing. Steps taken at home when handling and cooking food can help reduce the chance of illness, especially for households with babies on the way, young children, elderly folks, or those with compromised immune systems due to cancer treatment or other reasons.
Listeria monocytogenes emerged as a human foodborne pathogen in 1981 after an outbreak of illnesses in Nova Scotia, Canada linked to contaminated coleslaw. Although mothers’ symptoms can be mild, that outbreak involved 7 adults and 34 stillbirths and infant illnesses with 28% of cases resulting in death. A rash of several listeriosis outbreaks followed in the 80’s linked to milk and soft cheeses.
Foodborne illnesses like salmonella poisoning and listeriosis become more likely as the food supply chain becomes more complex and food is industrially processed. Listeria monocytogenes is hardy in food processing plants and hard to eradicate on equipment despite sanitation. A good example can be found in cold-smoked (aka lox) and hot-smoked salmon and other fish. Listeria is well-described in cold-smoked salmon as several outbreaks in Europe were traced, but cases stemming from hot-smoked fish have also been linked to cross-contamination on shared equipment. That’s why both smoked salmon and other cold-smoked fish products as well as hot-smoked varieties typically processed in the same environments are on the no-go list.
Listeria outbreaks are not uncommon. Pregnant women have a 10 to 18-fold higher risk than average for contracting listeriosis and a 100-fold increased risk compared to healthy non-pregnant women the same age. Alterations in their immune systems increase susceptibility. In 2023-4, there have been four outbreaks traced to leafy greens, ice cream, orchard fruit, and queso fresco and cotija cheese. Because expectant mothers are more likely to suffer illness and the consequences to the baby in utero are so serious, it’s best to avoid high risk foods.
Concerns over alcohol use during pregnancy arise from emerging understanding of its link to neurodevelopmental and behavioral problems now known collectively as Fetal Alcohol Spectrum Disorder. These behavioral and attentional problems have devastating effects on families, their children’s school lives, and social interactions. While the impact of alcohol is somewhat related to dose and timing, no safe level for drinking during pregnancy has been determined. Alcohol likely has effects at sensitive times in the baby’s growth and development. Since no safe amount or time during pregnancy is safe for the developing fetus, abstinence is advised.
Some studies have raised concern that caffeine consumption can increase miscarriage risk, but the collective data is not clear. Risks seemed to associate with the highest daily caffeine consumers. The American College of Obstetrics and Gynecology has determined, “moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth.” However, the statement recognizes that the “relationship of caffeine to growth restriction remains undetermined” and that a definitive determination cannot be made about the risk of high caffeine intake and miscarriage. An 8 ounce up of coffee, depending on the roast, typically contains about 80-140 mg of caffeine, so the equivalent of 200mg is about 1-2 cups daily. Black and green teas, chocolate, some energy drinks and coffee-flavored products like yogurts also contribute to caffeine intake.
Food safety in your kitchen will help avoid illness
Promptly refrigerate or freeze perishable food when returning from the supermarket
Sanitize surfaces like knives and cutting boards used for food prep, especially for any raw food.
Take extra care with ground meat and poultry as these are more frequently linked to outbreaks. Cook poultry and meat thoroughly. Use a meat thermometer to check that internal temperatures reach 165 degrees, if you can.
Keep leftovers for no more than four days in the refrigerator
Don’t defrost on the countertop; use the refrigerator, cold water, or microwave
Wash and pat dry fresh fruits and vegetables, including leafy greens like spinach, herbs, and salad greens.
Keep cut up fruit well-refrigerated
Avoid these High Risk Foods During Pregnancy
Raw or undercooked fish or shellfish, including sushi, and ceviche
Smoked seafood sold in the supermarket refrigerated case, including lox or labeled nova-style or kippered. Smoked salmon is safer to eat if cooked to 165 degrees.
Deli meat like cold cuts and sausages unless heated to 165°F
Purchased deli salads like chicken salad and potato salad more likely to be cross-contaminated. Make these from scratch at home.
Refrigerated pâté or meat spreads
Raw alfalfa and bean sprouts
Unpasteurized milk, juice, or cider and raw milk cheeses; soft cheeses like brie and camembert
Raw eggs used in products like Caesar salad dressing, cookie dough, eggnog
High mercury fish, Swordfish, King mackerel, Tile fish Shark, and limit fish consumption overall, including canned tuna, to 2 servings per week.
Alcohol
Getting Smoky Flavor Without Using Processed Meat
If craving that smoky flavor, I often use smoked paprika or lapsang souchong, Chinese smoked black tea, available in most grocery stores to add flavor in place of smoked fish and meat.
Smoky Braised Greens
Lapsang souchong is a Chinese black tea made by smoking the leaves over pine boughs. It imparts a complex smoky flavor to greens like collards or kale.Here are two examples of ways to get the complex flavor you crave.
1 lapsang souchong tea bag
1/4 cup water boiling water
1 head collard greens or kale, torn
Steep the teabag in the boiling water 3-4 minutes. Heat 1 Tbsp of olive oil in a skillet and add the greens. Sauté 1 minute. Add the tea and continue to sauté until the liquid fully evaporates. Season to taste.
Smoky Roasted Brussel Sprouts
Smoked paprika is available in sweet (dulce), bittersweet, and hot (picante) varieties. Versatile in the kitchen, it's a great addition to Brussel sprouts. Roasting in the oven on high heat avoids steaming and keeps them crisp tender.
1 1b. Brussel sprouts
2 tablespoons olive oil
1/2 teaspoon smoked paprika (sweet)
1/2 teaspoon ground coriander
1/4 teaspoon fine sea salt
1/4 teaspoon black pepper, fresh ground
Preheat the oven to 425 degrees. Line a rimmed baking sheet with aluminum foil or parchment.
Wash and trim the Brussel sprouts removing any bruised outer leaves. Cut each sprout in half.
Toss the sprouts in olive oil, smoked paprika and coriander. Distribute the sprouts cut-side up and season with salt and pepper.
Roast in the oven 25 minutes until the buds are tender and edges of the leaves begin to brown and crisp.