Nutrition in pregnancy

What to eat and what not to eat.

Maintaining a nutritious diet during pregnancy is important for your well-being in pregnancy and childbirth. It also significantly impacts the long-term health of your unborn child. However, it is essential to be aware of specific food items to avoid during pregnancy. We have compiled a list below for your reference.

CHEESE, MILK AND OTHER DAIRY

What you can eat:

• Pasteurised or unpasteurised hard and pasteurised semi-hard cheese like cheddar, gruyere, parmesan, edam, and stilton.
• Pasteurised soft cheese, such as cottage cheese, mozzarella, feta, cream cheese, paneer, ricotta, halloumi, goat’s cheese without a rind, and processed cheese spreads.
• Cooked soft or blue cheese, whether pasteurised or unpasteurised, until piping hot.
• Dairy products from pasteurised milk, such as milk, yogurt, cream, and ice cream.

What to avoid:

• Food made from unpasteurised milk: Unpasteurised cow’s milk, goat’s milk, sheep’s milk, or cream, as well as unpasteurised skimmed milk, Brie, feta, mozzarella cheese, and cottage cheese.
• Soft ripened goat’s cheese: Soft goat’s cheese from unpasteurised milk.
• Mould-ripened soft cheese with a white coating: Soft cheese like Brie, Camembert, and Chèvre with a white rind or coating unless cooked until piping hot.
• Soft blue cheese: Soft blue cheese like Danish blue, Gorgonzola, and Roquefort unless cooked until smoking hot.
• Avoid cider, juice, shakes, or smoothies that are not pasteurised.

Why should you avoid these:

Infection risk: Soft cheese with a white coating and unpasteurised dairy products carry a higher risk of Listeria contamination due to their moisture content. Listeria infection (listeriosis) can have consequences in pregnancy, as it can cause miscarriage, stillbirth, or sickness in the newborn. Cooking soft cheese until it is smoking hot is effective in decreasing the risk of listeriosis.

MEAT AND POULTRY:

What you can eat:

• Well-cooked meat like chicken, pork, and beef. They need to be prepared thoroughly with no trace of pink or blood. Use a meat thermometer to check.
• Cold-packed meat such as ham.

What to avoid or be careful with:

• Raw or undercooked meat.
• Cold-cured meats like salami, pepperoni, chorizo, and prosciutto unless well-cooked.
• Liver and liver products.
• All types of meat spreads, pâté, including vegetarian pâté.
• Game meats such as goose, partridge, venison, or pheasant.
• Cold burgers, hotdogs, and lunch meat.
• Liver and liver products.

Why should you avoid these:

Infection risk: Toxoplasmosis is an infection caused by the Toxoplasma parasite, found in raw and undercooked meat. Consuming raw or undercooked meat in pregnancy raises the risk of toxoplasmosis, which can cause miscarriage and other birth defects in your baby. Lead exposure: Game meats, such as venison or game birds, may contain lead shot or fragments, causing potential harmful lead exposure. Vitamin A excess: Liver and liver products have high levels of vitamin A, which is harmful in excess during pregnancy.

EGGS:

What you can eat:

• Eggs with the British Lion stamp (red lion stamp) are safe to consume during pregnancy. They can be eaten raw or partially cooked as soft-boiled.
• Food prepared with raw hen eggs from reputable sources like British Lion eggs or eggs produced under the Laid in Britain scheme (as mayonnaise and soufflé) are safe.
• If eggs (from hen, duck, goose, or quail) do not bear the British Lion stamp or under the Laid in Britain scheme, they can still be consumed as long as they are well-cooked. The egg white and yolk should be firm and not soft.

What to avoid:

• Raw or partially cooked hen’s eggs that are not British Lion or produced under the Laid in Britain scheme.
• Raw or partially cooked duck, goose, or quail eggs.

Why should you avoid these:

Infection risk: Eggs with the British Lion stamp and those produced under the Laid in Britain scheme ensure that the hens are vaccinated against Salmonella. While Salmonella is unlikely to directly harm an unborn baby, it can cause food poisoning in the mum, leading to complications such as dehydration.

FISH:

What you can eat:

• Well-cooked fish and seafood.
• Well-cooked sushi.
• Well-cooked shellfish, such as mussels, lobster, crab, prawns, scallops, and clams.
• Other sources of Omega-3 fatty acids such as flaxseeds, fortified food, and supplements.

How to cook fish:

Cook fish until it reaches an inside temperature of 145 degrees Fahrenheit (63 degrees Celsius). When well-cooked, fish easily flakes and has a consistent milky white color. For shrimp and lobsters, cook until their flesh is a pearly milky white in color. When cooking clams, mussels, and oysters, cook until their shells are well open; do not eat any that remain closed.

What to avoid/limit and why:

• Avoid ready-to-eat cold-smoked or cured fish.
• Limit tuna consumption: Tuna can contain higher levels of mercury, which can be harmful, particularly to the developing nervous system of the fetus. Limit consumption to no more than two tuna steaks or four medium-size cans of tuna per week.
• Avoid other fish with high mercury levels such as shark, swordfish, marlin, king mackerel, and tilefish.
• Limit oily fish: Some oily fish can contain higher levels of environmental pollutants. Consume no more than two portions of oily fish per week.
• Choose fish lower in contaminants such as freshwater trout, herring, and sardines.
• Avoid raw or partially cooked shellfish: They can carry harmful bacteria, viruses, or toxins that can cause food poisoning.

OTHER FOOD AND DRINKS:

• Caffeine: Limit intake to 200mg per day.
• Herbal teas: Limit consumption to 1 to 2 cups a day.
• Alcohol: Avoid completely during pregnancy.
• Liquorice: Safe, but avoid liquorice root.
• Fruits, vegetables, and salads: Thoroughly wash all raw fruits, vegetables, and salad ingredients. Avoid raw sprouts.
• Peanuts: Safe unless you have an allergy.
• Vitamins: Be cautious with high-dose multivitamin supplements, especially those with vitamin A.

References:

1. RCOG patient information leaflet: Information for you: Healthy eating and vitamin supplements in pregnancy. August 2022. Accessed at: RCOG Patient Information Leaflet
   
2. RCOG patient information leaflet: Being overweight in pregnancy. August 2022. Accessed at: RCOG Patient Information Leaflet
   
3. National Institute for Health and Care Excellence (NICE) Guidance: Maternal and child nutrition. Public health guideline [PH11]. Published: 26 March 2008, Last updated: 01 November 2014.
   
4. NHS England patient information leaflet: Have a healthy diet in pregnancy. Accessed at: NHS Patient Information Leaflet
   
5. NHS England leaflet: Foods to avoid in pregnancy. Accessed at: NHS Leaflet
   
6. WHO recommendations on antenatal care for a positive pregnancy experience: World Health Organization, 2016. Available at: WHO Recommendations
   
7. Keats EC, Haider BA, Tam E, et al. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2019;3:CD004905. Accessed at: Cochrane Database
   
8. WHO antenatal care recommendations for a positive pregnancy experience. Nutritional interventions update: multiple micronutrient supplements during pregnancy. Geneva, World Health Organization, 2020. Accessed at: WHO Antenatal Care Recommendations
   
9. Mayo Clinic leaflet: Pregnancy and fish: What’s safe to eat? 2024. Accessed at: Mayo Clinic Leaflet
   
10. Mayo Clinic leaflet: Pregnancy nutrition: Food to avoid during pregnancy. Accessed at: Mayo Clinic Leaflet