Is It Safe To Eat Sushi While You’re Pregnant?

It seems our appetite for sushi has never been higher. Global sales show that we can’t get enough of these nutrient-dense rolls made with rice, seaweed and ingredients like seafood and vegetables.

But if you’re pregnant, ordering off a sushi menu calls for some caution. Maternal-fetal medicine specialist Cara Dolin, MD, explains what’s safe to eat and what’s not.

The risks of eating sushi while pregnant

Many types of sushi feature raw or undercooked fish, which brings a heightened risk of bacteria and foodborne illness. That’s not ideal for anyone, of course — but when you’re pregnant, the potential danger is especially high.

That’s because bacteria (especially Listeria) can lead to a miscarriage or stillbirth, as well as newborn death due to infection, says Dr. Dolin.

Babies born with a Listeria infection also could experience:

• Paralysis
• Seizures
• Blindness
• Developmental delays or differences
• Organ damage or failure

“The bacteria specifically target the hematologic [blood] system of the baby,” she explains. “It can affect the brain and liver — and that can bring some serious consequences.”

Other concerns from eating raw fish include:

• Mercury: Certain seafood can be high in mercury, a toxic heavy metal that can harm a developing fetus and cause neurological issues. Prenatal mercury exposure can lead to future developmental delays and motor skill issues.
• Parasites: Fish can harbor parasites that swim in the same waters. Eating raw or undercooked fish increases the likelihood that you could consume one of those nasty buggers, which could lead to pregnancy complications that endanger your fetus.

Given all of the above risks, it’s recommended that women immediately stop eating raw or undercooked fish once they learn they’re pregnant. It’s not a bad idea to adjust if you’re trying to conceive, too.

What types of sushi are off-limits?

During pregnancy, it’s best to avoid any sushi with raw or undercooked (seared) fish to limit potential exposure to bacteria and parasites, emphasizes Dr. Dolin. That covers various types of sushi, like:

• Sashimi
• Nigiri
• Maki

Mercury can be an issue in raw seafood, too, but it’s also a concern in cooked seafood. So, how can you avoid it in your sushi? It starts with passing on rolls made from certain types of fish known to have higher levels of mercury.

Those tend to be larger, predatory fish that eat smaller fish to accumulate more mercury in their bodies, she says. The list includes:

• Shark
• Swordfish
• Marlin
• Bigeye tuna

Safe sushi options during pregnancy

So, what type of sushi can hit your plate? In general, sushi rolls made with cooked fish or vegetables should be safe, says Dr. Dolin. That would include:

• California rolls filled with cooked imitation crab (which is made from a paste of white fish, most often Alaska pollock)
• Sushi made with fully cooked fish, ideally low-mercury seafood like salmon, eel and shrimp
• Vegan or vegetarian rolls made with cucumbers, avocados, carrots and other plant-based fillings
• Tamago sushi (provided the egg is firm and thoroughly cooked)

But one important note: Make sure that you’re getting your sushi from a reputable restaurant or vendors that follow food safety standards. Cross-contamination with raw fish can be an issue.

“If they prep a veggie roll on the same surface where they prep raw fish rolls, you could get exposed to exactly what you’re trying to avoid,” notes Dr. Dolin.

Is it best to avoid sushi (and fish) while pregnant?

Dr. Dolin stresses that sushi — and fish in general — can be part of a healthy pregnancy diet. The key is moderation. That means no more than two to three 4-ounce servings of low-mercury fish per week.

The U.S. Food and Drug Administration (FDA) classifies fish as “best choice,” “good choice” and “choices to avoid” when it comes to mercury levels. You can see its recommendations here.

“Fish is actually healthy to eat during pregnancy,” says Dr. Dolin. “It can be a great source of omega-3 fatty acids, which are important for fetal brain development. So, don’t feel like you have to cut fish entirely from your diet. Just eat it safely.”