It has been announced that if you're pregnant or considered otherwise vulnerable you should now avoid eating smoked fish - such as smoked salmon, due to the risk of contracting listeria monocytogenes.
Smoked fish isn't the only food those who are pregnant should avoid, and when trying to find out what's safe and what's seen as high-risk, it can be confusing to separate fact from fiction.
It's as much about including foods that can be beneficial to your baby as it is about avoiding foods that may be harmful. You needn’t feel deprived during these exciting nine months if you know the facts.
Advice changes and differs from country to country. This information is consistent with the NHS advice.
Foods to eat during pregnancy
With a few exceptions, pregnant women should follow the same healthy and varied diet that’s recommended to everyone. Eat plenty of fruit and vegetables, wholegrains, lean meats or vegetarian protein foods such as beans, lentils and pulses. Drink lots of water, too.
Pregnant women need to ensure they are getting enough calcium, so try to include lower-fat milk products such as natural yoghurt, semi-skimmed milk, or calcium-fortified non-dairy products in your daily diet.
Don't be tempted to "eat for two". Pregnant women need surprisingly few extra calories each day. The inevitable fatigue and cravings may make you reach for a quick pick-me-up in the confectionery aisle. Keep sweets and treats to a minimum and opt for slow-release energy foods that give you more of the vitamins and minerals you need.
Foods to check
Fish and mercury
Shark, swordfish and marlin are off the menu for pregnant women because they can carry sufficient amounts of mercury to harm your baby. Other, smaller oily fish can also contain mercury so the advice for pregnant women is to eat no more than two 140g portions per week of mackerel, salmon, sardines, anchovies, trout or other oily fish.
That said, pregnant women should try to include these two portions of oily fish to ensure they get enough omega-3 fatty acids to help their growing baby’s brain development.
Omega-3
Getting enough omega-3 during pregnancy is important, but it can be confusing to understand which foods provide what you need.
Omega-3 fatty acids fall into two categories:
- ALA: found in a range of plant sources, including chia seeds, ground flaxseed, rapeseed oil, walnuts, hazelnuts, pecans and green leafy vegetables. ALA can’t be made by the body so it’s important to get enough from these sources. Omega-3 enriched eggs are also a good source.
- DHA and EPA: long-chain omega-3 fats have important benefits to brain development, especially in pregnant women and young children. The body can make these from ALA but not as efficiently as consuming them directly. Fish oil and microalgae-based omega-3 supplements are available, as are omega-3 enriched eggs.
Fish liver oil supplements should be avoided because they also carry high amounts of vitamin A.
Cheese
Soft cheeses with a soft white rind (brie, camembert, taleggio, etc) and soft blue cheeses (gorgonzola, dolcelatte, Danish blue) should be avoided unless they are cooked until steaming hot all the way through. This is because they may carry listeria, which can cause serious illness in pregnancy.
Hard cheeses such as Cheddar, Parmesan and stilton are fine to eat, even if they are made with unpasteurised milk. The high acidity and low water content in these cheeses make them inhospitable places for bacteria to grow.
Soft cheeses made from pasteurised milk are ok to eat, too. Check the label on mozzarella, feta, halloumi, ricotta, goats’ cheese and paneer.
Eggs
The advice on undercooked eggs in pregnancy changed in 2017. It’s now considered safe to eat raw or lightly cooked hen’s eggs if they carry the British Lion mark stamped on the shell. This mark shows that the producer has adhered to the Lion Code of Practice and the eggs will be free from salmonella.
If you have eggs from a neighbour or another source, be sure to cook both the white and yolk thoroughly before eating.
Duck, goose and quail eggs should always be cooked thoroughly.
Caffeinated drinks
While having some caffeine is fine, the advice is not to exceed 200mg per day. High caffeine consumption has been linked to low birthweight in babies. Caffeine quantities vary wildly in coffee-based and fizzy drinks. A medium cappuccino from a high street chain could contain up to 195mg of caffeine. On average, a mug of tea contains 75mg of caffeine and a mug of instant coffee contains 100mg of caffeine. A mug of filter or cafetiere coffee contains about 135mg of caffeine.
If you can’t face giving up your coffee during pregnancy, switch to decaf or even blend decaf and regular coffee to make a “half-caf”.
Foods to avoid
Smoked fish
Due to the risk listeria poses, smoked fish – both hot (including smoked mackerel and hot smoked salmon and pate) and cold (including smoked salmon) – should now be avoided unless it's thoroughly cooked.
The Food Standards Agency explain: 'Listeriosis in pregnancy can cause miscarriages and severe sepsis or meningitis in new-born babies.'
Dr Caroline Handford, Acting Head of Incidents at the Food Standards Agency adds: "While the risks to the general public of becoming seriously ill due to listeria are very low, we need people who are vulnerable – specifically those over 65, pregnant women and people with weakened immune systems – to be aware of the ongoing risks of consuming ready to eat smoked fish. If anyone from these groups is eating ready to eat smoked fish, we are reminding them of the advice to ensure that it is thoroughly cooked before they eat it including when served as part of a dish.
“People can also further reduce the risk by keeping chilled ready to eat smoked fish cold (5⁰C or below), always using products by their use-by date, following the storage instructions on the label, and cooking it until it is piping hot right through.”
Cured and undercooked meat
Meat should be cooked through completely due to the risk of toxoplasmosis-carrying parasites. This includes steaks, roasts, burgers, sausages, poultry and pork.
Pepperoni, salami, chorizo and air-dried hams may contain these parasites as well, so the safest option is to eat them cooked.
Liver, haggis and pâté
Because of the high vitamin A content, pregnant women are advised not to eat liver or products containing liver (sausage, pâté and haggis). Pâté has an added danger of listeria.
Raw milk and raw yoghurt
These foods aren’t widely available, but should be avoided due to the risk of listeria contamination.
Supplements
Folic acid
Pregnant women are advised to take a 400-microgram folic acid supplement every day throughout the first 12 weeks of their pregnancy. Folic acid helps to prevent spinal defects (especially spina bifida) as your baby develops. Foods such as leafy greens contain folic acid, and you should eat plenty of these, but the levels you can get from diet alone aren’t considered sufficient enough for pregnant women.
Vitamin D
All adults, including pregnant women, are encouraged to take a 10-microgram vitamin D supplement each day. Vitamin D is made by the body from exposure to sunlight so is particularly a problem in the winter. People who have dark skin or keep their skin well-covered outdoors probably need to take a supplement in the summer, too.
Iron
Some women suffer from iron-deficiency during pregnancy. It’s difficult to know whether fatigue is caused by this or just by being pregnant. A diet rich in red meat, nuts, dried fruit and leafy greens may be enough to provide the iron you need. Your doctor or midwife will be able to advise if you would benefit from a supplement as well.
Multivitamin supplements
There are multivitamin supplements aimed specifically at pregnant women. If you are struggling to eat because of nausea or sickness, these may be helpful. High-dose multivitamins or any supplements containing vitamin A should be avoided. If you’re unsure if you need a vitamin supplement, or which one to take, talk it over with your doctor or midwife.
