Quick Answer
It is usually recommended that pregnant women avoid raw fish and shellfish, including sushi made with raw fish. This is because raw seafood carries a risk of parasitic and bacterial infections that can be harmful to a developing baby. However, some types of sushi made with cooked fish or vegetables may be safe to eat in moderation during pregnancy. Discuss sushi consumption with your doctor.
Should Pregnant Women Avoid Sushi Completely?
Many healthcare providers recommend that pregnant women avoid sushi and other raw seafood entirely. Eating raw fish exposes pregnant women to several risks:
- Parasites – Raw fish can contain parasitic worms that cause infections like anisakiasis, which can be dangerous during pregnancy.
- Bacteria – Raw seafood may contain harmful bacteria like Listeria, Salmonella, Vibrio, and others that can cause food poisoning and pregnancy complications.
- Mercury – Large fish like tuna can contain high mercury levels, which can harm fetal brain development when eaten regularly.
- Allergic reactions – Some people may be allergic to ingredients in sushi like seaweed and fish eggs.
For these reasons, the FDA and other health organizations advise pregnant women to avoid sushi and other raw or undercooked seafood. Many ob-gyns and midwives say it’s better to be safe than sorry and recommend pregnant patients skip sushi completely.
However, some types of vegetarian sushi or sushi made with cooked fish may be safe in moderation. Discuss your sushi options with your doctor.
Are Some Types of Sushi Safer During Pregnancy?
Not all sushi contains raw fish. Some types of vegetarian sushi or sushi made with thoroughly cooked fish may be safe for pregnant women to eat in moderation.
Here are some possibly safer sushi options to discuss with your doctor:
- Vegetarian sushi – Types like inari, vegetable rolls, or cucumber rolls contain no raw fish.
- Cooked fish sushi – Sushi with fried fish or smoked salmon is cooked to kill bacteria and parasites.
- Low-mercury fish – Salmon sushi may have less mercury risk compared to tuna and other high-mercury fish.
Pregnant women should still take precautions around these types of sushi:
- Avoid sushi from restaurants with questionable food safety practices.
- Don’t choose sushi with raw sprouts, which can contain bacteria.
- Limit sushi meals to no more than 1-2 times per week.
Talk to your doctor about any sushi or cooked fish consumption during pregnancy. While not completely risk-free, some types of sushi may be less concerning than others.
What Are the Risks of Eating Raw Fish During Pregnancy?
Here is more detail on the potential risks linked to consuming raw seafood during pregnancy and why doctors recommend avoiding sushi with raw fish:
Parasitic Infections
Eating raw or undercooked fish and shellfish can expose pregnant women to parasitic worms that cause anisakiasis, tapeworm, and other gastrointestinal infections. Parasites in raw seafood are killed by cooking to 145°F or freezing at -4°F for 7 days.
Anisakiasis affects about 2,000 Americans each year. Once ingested, parasitic larvae can penetrate the intestinal wall and cause symptoms like nausea, vomiting, and abdominal pain. This illness can progress to a serious condition during pregnancy.
Tapeworm infection is also a risk with raw seafood. Large tapeworms during pregnancy may block vital nutrients and increase the risk of premature birth or low birth weight.
Bacterial Illnesses
Raw seafood may contain several types of dangerous bacteria, such as:
- Salmonella – Causes salmonellosis food poisoning
- Vibrio – Causes vibriosis
- Listeria – Causes listeriosis
- E. coli – Causes gastrointestinal illness
Pregnant women are 10 times more likely than others to get listeriosis from food. Listeria infection during pregnancy can lead to miscarriage, stillbirth, and other complications.
Other bacteria like Salmonella and Vibrio also cause more severe illness during pregnancy and can infect the amniotic fluid, uterus, and fetus.
Mercury Exposure
Certain types of seafood contain high levels of mercury, such as:
- Shark
- Swordfish
- King mackerel
- Tilefish
- Bigeye and ahi tuna
Too much mercury during pregnancy can impair neurological development. Excessive tuna sushi consumption, for example, may increase blood mercury levels and affect fetal brain and nervous system growth.
The FDA recommends pregnant women eat no more than 3-6 ounces of low-mercury fish per week to avoid dangerous mercury exposure.
Food Allergies
Some pregnant women may be allergic to common sushi ingredients like seaweed, fish roe, octopus, eel, or shellfish. Food allergy symptoms like hives, swelling, and anaphylaxis can be dangerous during pregnancy.
Talk to your doctor about any food allergies before eating sushi while pregnant.
Guidelines for Pregnant Women Eating Sushi
Most healthcare providers recommend following these precautions related to sushi consumption during pregnancy:
- Avoid all raw fish and shellfish sushi. Choose vegetarian or cooked fish sushi instead.
- Avoid high-mercury fish like tuna, shark, and swordfish.
- Only eat sushi from reputable restaurants with safe food handling practices.
- Limit sushi to 1-2 meals per week at most.
- Don’t eat refrigerated sushi meals older than 1-2 days.
- Avoid sushi containing raw sprouts or eggs.
- Don’t eat sushi if you have any food allergy symptoms.
Talk to your prenatal doctor about your preferences for including sushi in your pregnancy diet. While not recommended, some types of sushi may be safer than others if consumed in moderation.
Healthier Sushi Alternatives During Pregnancy
Instead of raw fish and shellfish sushi, pregnant women can satisfy sushi cravings with these healthier rolled alternatives:
Vegetable Sushi
Vegetable sushi contains no raw seafood. Fillings may include cooked yam, avocado, cucumber, tomato, bell pepper, pickled daikon radish, carrot, spinach, corn, mushrooms, or inari fried tofu pouches.
Vegetable sushi has fiber, vitamins, and minerals without the risks of raw fish. Select rolls without unpasteurized cheese, sprouts, or overly spicy sauces.
Cooked or Smoked Fish Sushi
Sushi containing ingredients like shrimp tempura, cooked crab, grilled eel, or smoked salmon are cooked to eliminate bacteria and parasites.
A California roll with cooked crab and avocado is a popular pregnancy sushi choice. Non-tuna versions like a salmon or yellowtail roll may also be safer.
Cooked Veggie Sushi Rolls
Try sushi rolls made with cooked veggie proteins like tofu, edamame, or Impossible plant-based “meat.” Pair with veggies like cucumber, bell pepper, or mango for extra nutrients.
A tofu, avocado, and cucumber sushi roll offers a healthy balance of plant-based protein and produce.
Fruit Sushi
Some sushi spots offer fruit-based rolls featuring mango, pineapple, apple, berries, orange, and more.
Fruit sushi makes a refreshing option that packs nutrients pregnant women need like vitamin C, fiber, and antioxidants.
Alternative “Sushi” Bowls
DIY “sushi” bowls at home contain the flavors of sushi in a pregnancy-friendly rice bowl form.
Ingredients like cooked sushi-grade fish, imitation crab, avocado, cucumber, pickled ginger, and sushi rice can be assembled into a tasty sushi bowl.
Key Takeaways on Eating Sushi During Pregnancy
Here are some main points to remember about sushi consumption during pregnancy:
- Raw seafood poses risks of parasitic and bacterial infections. Avoid raw fish sushi.
- Certain types of cooked sushi may be safer in moderation. Discuss with your doctor.
- Prioritize vegetable rolls, cooked fish, smoked salmon, shrimp, or imitation crab.
- Avoid high-mercury fish like tuna and limit sushi to 1-2 times per week.
- Only choose sushi from restaurants with reputable food safety practices.
- Talk to your doctor about any food allergies before trying new sushi.
While risky, not all sushi is strictly off-limits during pregnancy. Some cooked and vegetarian varieties may be reasonable for expectant mothers to eat in moderation.
Discuss your preferences with your prenatal care provider for personalized advice about including sushi in your pregnancy diet.
