It seems like the second you become pregnant, you’re bombarded with non-stop advice about what you should and shouldn’t do. From the supplements you take to how you sleep, there’s always someone with an opinion about what’s safe for your growing baby, and some of it can be conflicting. What you hear from your neighbor or well-meaning auntie might not line up with your doctor’s recommendations, especially when it comes to food. Sushi is one of those foods people are a bit confused about, especially since the advice surrounding sushi in pregnancy can vary depending on where you live.

Can pregnant women eat sushi? It depends on the type. Here’s what to know.

Experts recommend avoiding raw sushi in pregnancy

US health experts (including the Food and Drug Association (FDA) and American College of Obstetricians and Gynecologists (ACOG) recommend pregnant women avoid raw foods, including sushi made with raw fish.

Sushi is a Japanese dish typically made with rice and fish, but it can also be made with other seafood or vegetables. Lucky Sekhon, MD, a double-board certified OB/GYN and infertility expert at RMA of New York, advises her patients to avoid all raw, uncooked, or undercooked foods during pregnancy, which includes sushi made with raw fish.

Related: The scientific reason why that first post-birth meal tastes *so* good

SpecialAnniversary ArticlesCTA 01 2

Why is eating sushi a potential risk during pregnancy?

Pregnancy alters your immune system, so you can be more at risk of getting sick from bacteria or other pathogens in food. “Undercooked or raw fish, often found in sushi, can lead to foodborne illnesses more often than in non-pregnant patients as the pregnant state is a state of relative immunocompromise,” Dr. Sekhon advises.

Listeria is an example of a foodborne bacteria that can cause listeriosis, a severe infection that pregnant women are 10 times more likely to get than non-pregnant adults. Listeriosis can lead to miscarriage, stillbirth, or preterm labor.

Related: 10 foods to avoid during pregnancy—and why

Not everything raw will contain listeria, but since heat destroys it (along with other potentially pathogenic bacteria or parasites), it’s best to avoid uncooked foods.

But here’s the thing that’s often missed in conversations about sushi and pregnancy. You don’t have to completely eliminate sushi from your diet to stay safe—you can still eat it. “Sushi that involves cooked fish or shellfish can be safe and fine in pregnancy,” Dr. Sekhon shares. So cooked rolls are usually A-OK.

Why do US recommendations about sushi and pregnancy differ from some other countries?

Things get a little more confusing when you look at guidelines for countries outside the United States. For example, according to the National Health Service Wales, raw fish sushi is safe if frozen first.

So why the difference? “The US tends to be more conservative and cautious when it comes to pregnancy guidelines,” Dr. Sekhon explains. “The UK guidance is that flash-frozen sushi probably kills off parasites or eggs and reduces the risk of infection.”

But if you live in the US, your OB/GYN is likely to recommend avoiding sushi made with raw fish altogether, just to be safe.

Related: Heavy metal toxins abound in baby food too, report finds

Love fish? No need to avoid it while pregnant

“Fish consumption can be healthy in small to moderate amounts in pregnancy because of the high concentrations of omega-3 polyunsaturated fatty acids and protein, which is important to fetal brain development,” says Dr. Sekhon.

Even though all fish contain small amounts of mercury, the benefits outweigh the risks. Studies show that children exposed to nutrients from fish before birth have higher IQ and communication development and positive outcomes for verbal, memory, and motor scores.

Two to three 4-ounce servings of cooked fish a week are considered safe and beneficial. The trick is to choose fish lower in mercury like shrimp, salmon, catfish, pollock, and canned light tuna.

“Avoid high-mercury containing fish such as shark, swordfish, king mackerel, and tilefish,” Dr. Sekhon says. Too much mercury can harm a baby’s developing nervous system (here’s a great chart to help you determine which fish are the best choices).

The bottom line: Choose cooked or baked sushi rolls for lower health risks during pregnancy

The choice to eat sushi during pregnancy ultimately comes down to you and your OB-GYN. Some women feel overburdened by all the rules and restrictions of pregnancy, while others find comfort and peace of mind in erring on the side of caution.

If you’re craving sushi, choosing a low mercury, cooked roll from a reputable restaurant is probably your best bet.

Featured expert

Lucky Sekhon, MD, is a double-board certified OB-GYN and infertility expert at RMA of New York.

Sources:

Bramante CT, Spiller P, Landa M. Fish Consumption During Pregnancy: An Opportunity, Not a Risk. JAMA Pediatr. 2018;172(9):801-802. doi:10.1001/jamapediatrics.2018.1619