What to Eat (and Avoid) When You're Pregnant

By: Lainey Younkin, M.S, R.D.  |  EatingWell.com, August 2016

Here's the latest research on the foods and drinks you've been told to avoid. Plus, get the scoop on what's OK to eat when you are pregnant.

Getting pregnant is usually an exciting time. Avoiding lattes and red wine for nine months? Not so much. But is it really necessary to cut out caffeine, alcohol, cheese and sushi while you are pregnant? Here's the latest research on what to avoid and what to be cautious about. Plus, learn which foods and key nutrients you should definitely eat for a healthy pregnancy and baby.

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Foods to Avoid or Approach with Caution

Meat (cold cuts, hot dogs, burgers and more): Eating meat during pregnancy is safe, as long as it is cooked. So say goodbye to rare burgers and steaks—if that's your thing. Eating raw or undercooked meat can expose you to two dangerous bacteria, Listeria and Toxoplasma. Listeriosis can cross the placenta and increase the risk of miscarriage, preterm labor or stillbirth.
According to the American Congress of Obstetricians and Gynecologists, the risk of pregnant women getting listeriosis is 13 times higher than the general population. However, your risk is still relatively low. One 2015 study found that when 10,000 pregnant women were exposed to Listeria, only one actually got sick with listeriosis. Bottom line: you can eat deli meats, hot dogs and sausages as long as they are heated until steaming (165°F). However, hot dogs and sausages aren't the most nutritious choice for you or baby, so heat—and eat—them in moderation.
Soft cheeses: You may have heard to stay away from some cheeses if you are pregnant. But feta, Brie, Camembert and other soft cheeses are safe to eat as long as they are made from pasteurized milk. Pasteurization destroys harmful bacteria, but eating unpasteurized cheeses carries a risk of exposure to Listeria or E Coli. You don't want to take that risk when you are pregnant since these infections can harm both you and your baby. Be sure to check the label on your cheese, which will let you know if it's pasteurized. Most soft cheeses at the supermarket are actually made with pasteurized milk. If you're eating out, ask your server if the cheese you're ordering is pasteurized.
Eggs: Pregnant or not, eating raw or undercooked eggs can cause foodborne illness from Salmonella. However, it's estimated that in the U.S. only 1 in 10,000 to 1 in 30,000 eggs is infected with Salmonella. If you do get sick, you'll suffer from a combination of nausea, stomach cramps, diarrhea or vomiting, but it shouldn't affect your growing baby. In rare instances, bacteria can get into your blood, which could cause sepsis in the uterus, a life-threatening infection. To stay on the safe side, cook eggs thoroughly (no runny yolks) and avoid raw eggs in raw dough and batter, homemade condiments like Caesar dressing and mayonnaise, and homemade ice creams.
Fish: Many women have been scared away from eating fish during pregnancy due to the mercury content, but not all fish are created equal. In fact, certain types of fish are good for your baby's development (see Omega-3s below). Avoid shark, swordfish, mackerel, tilefish and tuna steaks, which are high in mercury. Mercury can interfere with the baby's developing nervous system and brain. Otherwise, it is safe to consume up to 12 ounces of low-mercury fish each week. This includes salmon, trout, sardines, shrimp and canned tuna. Limit canned albacore tuna to no more than 6 ounces per week, which is about one standard can.
Sushi: Steer clear of sushi, smoked seafood and ceviche. Raw fish and shellfish could be contaminated with fish-borne parasites or Norovirus. Fish-borne parasites can cause anemia in the mother, decreasing the supply of oxygen and nutrients to the growing baby.
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Coffee: It's recommended that during pregnancy you limit your caffeine intake to 200 mg daily (about 1.5 cups of coffee). The research on caffeine consumption during pregnancy is conflicting. Studies have raised concerns about too much caffeine and miscarriages, preterm birth and low birth weight. While some studies show no relationship between caffeine intake and miscarriages, one study found that when women had higher amounts of caffeine (> 200 mg per day), they had an increased risk of miscarriage. More studies are needed in this area. There is also not enough evidence to confirm that caffeine causes growth restrictions. For now, you can enjoy a cup (or two) of java every day, which keeps you in the recommended range of less than 200 mg of caffeine. One 8-ounce cup of coffee has about 137 mg caffeine. Fun fact: Espresso has less (about 65-75 mg caffeine in one shot), so order a latte if you want to be extra cautious.
Alcohol: You've heard it before: no amount of alcohol is considered safe in pregnancy. Heavy alcohol consumption is associated with fetal alcohol syndrome (FAS), birth defects and neurodevelopment disorders. But, what about an occasional drink? While the research on this isn't as clear, your doctor will still tell you to abstain completely during pregnancy. One 2016 study found that drinking low to moderate amounts of alcohol throughout pregnancy did not increase risk of low birth weight, preterm delivery or birth defects. The problem is that no study has been able to define exactly how much alcohol is safe, leading to the recommendation, in the U.S., to stay away altogether (in Europe, guidelines are slightly less strict). Binge drinking (5-6 drinks at one time), on the other hand, is very likely to do damage to your baby and isn't healthy whether you're pregnant or not. Bottom line: We don't know the effects of moderate alcohol consumption on the fetus. Drinking a large amount at one time is going to do the most harm, much more than one drink a few times throughout your pregnancy. To have the safest pregnancy, avoid alcohol altogether. And if you're considering a glass of wine here and there, you should speak with your doctor about the risks.
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Key Nutrients to Include

A healthy pregnancy diet isn't just about foods to avoid—you want to make sure you're getting more healthy foods and nutrients for you and your baby. You'll want to eat a balanced diet while you're pregnant—lots of vegetables, fruits, whole grains, healthy proteins. And even though it may seem fun to "eat for two," for most of your pregnancy your calorie needs grow modestly. During the first trimester your calorie needs are about the same as pre-pregnancy. For the second trimester, your needs go up by about 340 calories daily. In the third trimester, you'll need an additional 450 calories from where you started pre-baby, or about 110 more than the second trimester. So give in to those pregnancy cravings occasionally (they happen, right?) but focus on filling up with healthy foods and getting more of these key nutrients.
Folic acid: Folic acid is important for reducing neural tube defects, which could lead to spina bifida and spinal cord disorders. While it's important to eat foods high in folic acid throughout pregnancy, you may ultimately need to take a prenatal vitamin to get the recommended amount: 400-800 mcg per day. The Centers for Disease Control recommend that women take a prenatal vitamin with folic acid for at least one month before getting pregnant since spinal defects occur 3 to 4 weeks after conception. Dark leafy greens, fortified breakfast cereals, cantelope, honeydew, orange juice and beans are good food sorces of folic acid.
Iron: Since your blood volume increases during pregnancy, iron is essential to make sure you and your baby are getting enough oxygen. Adequate iron intake also prevents fatigue, weakness and anemia. Choose a prenatal vitamin with iron, and eat foods high in iron such as meat, fortified breakfast cereals, raisins, beans and lentils . Iron from meat is more easily absorbed, but if you eat foods high in vitamin C with iron-rich foods, it will increase iron absorption. Caffeine can block the absorption of iron so leave 1 to 3 hours between your coffee and iron.
Omega-3s: There are two main classes of omega-3 fatty acids—eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both are crucial for the development of a baby's brain and eyes, and they must be obtained through mom's diet because the body doesn't make them. Fatty fish, such as salmon and albacore tuna, are high in omega-3s. But with the recommendation for pregnant women to eat less than 12 ounces of fish per week, it is difficult to meet omega-3 requirements through diet alone. Two servings of fatty fish per week provide 50-100 mg of DHA, but pregnant women should aim for 300 mg DHA daily. For optimal intake, take a prenatal vitamin with DHA or a fish oil supplement. While plant sources of healthy fats, such as flaxseed, contain omega-3s, it's a different type that is poorly converted to DHA in the body.
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Bottom Line

Be cautious about what you consume when you're pregnant, but don't beat yourself up or feel guilty if you occasionally eat or drink something from the no-no list. Remember that the chance of getting sick is all about dose: how much and how often you consume these foods and drinks. You also don't have to worry about something you ate months ago. If you got a foodborne illness, you would know within 24 to 48 hours. For the optimal health of you and your baby, eat a variety of foods, mostly fruits, vegetables, whole grains and lean protein. By mixing it up each day, you will minimize your risk of exposing yourself and your baby to harmful bacteria and infections, while ensuring baby gets all the vitamins and minerals needed to be healthy.
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