Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

When you're pregnant, nutrition is more important than ever. You need more of many important nutrients than you did before pregnancy. Making healthy food choices every day will help you give your baby what they need to develop. It will also help make sure that you and your baby gain a healthy amount of weight.

You need more folic acid, iron, calcium, and vitamin D than you did before pregnancy:

• Folic acid is a B vitamin that may help prevent neural tube defects.
  • Before pregnancy, you need 400 mcg (micrograms) per day.
  • During pregnancy and when breastfeeding, you need 600 mcg per day from foods and/or vitamins. It is hard to get this amount from foods alone, so you will most likely need to take a supplement that contains folic acid.
• Iron is important for your baby's growth and brain development. During pregnancy, the amount of blood in your body increases, so you need more iron for yourself and your growing baby. You should get 27 mg (milligrams) of iron a day.
• Calcium during pregnancy can reduce your risk of preeclampsia. It's a serious medical condition that causes a sudden increase in your blood pressure. Calcium also builds up your baby's bones and teeth.
• Pregnant adults should get 1,000 mg (milligrams) of calcium a day
• Pregnant teenagers (ages 14-18) need 1,300 mg of calcium a day
• Vitamin D helps the calcium to build your baby's bones and teeth. All women, pregnant or not, should be getting 600 IU (international units) of vitamin D per day.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. Only take vitamins and mineral supplements that your health care provider recommends.

You also need more protein when you are pregnant. Healthy sources of protein include beans, peas, eggs, lean meats, seafood, and unsalted nuts and seeds.

Getting enough fluids is another special nutritional concern during pregnancy. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. So it's important to drink enough fluids every day.

Everyone who can get pregnant or is planning to get pregnant needs to take a daily supplement with 400 to 800 micrograms (mcg) of folic acid. It’s important to take a folic acid supplement in addition to following a healthy eating routine.

Why is folic acid important?

Folic acid is a type of folate added to supplements and foods. Folate is a vitamin that’s especially important if you’re pregnant or may become pregnant. It can help prevent serious problems with your baby’s brain and spine.

Getting enough folic acid is important even when you aren’t planning to get pregnant. It’s most important to take folic acid at least 1 month before you get pregnant and through the first 3 months of pregnancy.

Talk with your doctor about folic acid.

Vitamins

How can I get enough folic acid?

You can take a multivitamin or a supplement pill that has only folic acid. You can find vitamins and folic acid pills at most pharmacies and grocery stores.

Be sure to check the label and choose a pill with 400 to 800 mcg of folic acid. This label shows a supplement with 400 mcg folic acid.

Make it easy to remember.

• Take it at the same time every day — for example, take it when you brush your teeth in the morning or when you eat breakfast
• Leave the vitamin bottle somewhere you’ll notice it every day, like on the kitchen counter

Eat Healthy

In addition to taking a folic acid supplement, it’s important to follow a healthy eating routine.

Make sure to include foods with folate in your eating routine. Many healthy foods have folate, including:

• Spinach and other leafy greens
• Asparagus
• Oranges and orange juice
• Beans and peas

Folic acid is also added to foods like many cereals, breads, pastas, and other foods made with grains. Check the labels and choose foods with folic acid.

Yes. During pregnancy, your body needs more iron to support your growing baby. In fact, pregnant women need almost twice as much iron as women who are not pregnant do. Not getting enough iron during pregnancy raises your risk for premature birth or a low-birth-weight baby (less than 5 ½ pounds). Premature birth is the most common cause of infant death. Both premature birth and low birth weight raise your baby's risk for health and developmental problems at birth and during childhood.

If you're pregnant, talk to your doctor about these steps:

• Getting 27 milligrams of iron every day. Take a prenatal vitamin with iron every day, or talk to your doctor about taking an iron supplement (pill).
• Testing for iron-deficiency anemia
• Testing for iron-deficiency anemia four to six weeks after childbirth

How many calories you need depends on your weight gain goals. Your provider can tell you what your goal should be, based on things like your weight before pregnancy, your age, and how fast you gain weight. The general recommendations are:

• In the first trimester of pregnancy, you probably do not need extra calories
• In the second trimester, you usually need about 340 extra calories
• In the last trimester, you may need around 450 extra calories per day
• During the final weeks of pregnancy, you may not need extra calories

Keep in mind that not all calories are equal. You should eat healthy foods that are packed with nutrients - not "empty calories" such as those found in soft drinks, candies, and desserts.

When you are pregnant, you need more of certain nutrients like protein, iron, folic acid, and iodine. It’s also important to get enough calcium.

Making smart food choices can help you have a healthy pregnancy and a healthy baby. Here are some ideas to help you eat healthy during pregnancy.

Follow a healthy eating pattern.

Eating healthy means following a healthy eating pattern that includes a variety of nutritious foods and drinks.

• Eat a variety of vegetables, fruits, whole grains, fat-free or low-fat dairy products, and protein foods.
• Choose foods and drinks with less added sugars, saturated fats, and sodium (salt).
• Limit refined grains and starches, which are in foods like cookies, white bread, and some snack foods.
• If you are feeling sick, try eating a piece of whole-grain toast or whole-grain crackers.

Get the right amount of calories for you.

Being pregnant doesn't mean you need to eat twice as much food.

• First trimester (first 12 weeks) – Most women don’t need any extra calories.
• Second trimester (13 to 26 weeks) – Most women need about 340 extra calories a day.
• Last trimester (after 26 weeks) – Most women need about 450 extra calories a day.

Ask your doctor or midwife about the right amount of calories for you during pregnancy.

Make healthy snack choices.

Examples of healthy snacks include:

• Low-fat or fat-free yogurt with fruit (look for options with no added sugar)
• Whole-grain crackers with fat-free or low-fat cheese
• Carrots with hummus

Take a prenatal vitamin with folic acid, iron, and iodine every day.

• Folic acid helps prevent some birth defects of the brain and spine.
• Iron and iodine help keep you and your baby healthy.

Talk with your doctor or nurse about a prenatal vitamin that’s right for you.

Eat 8 to 12 ounces of seafood each week.

Fish and shellfish have healthy fats that are good for you and your baby. But some fish is high in mercury, a metal that can hurt your baby’s development. It’s a good idea to eat seafood that is high in healthy fats but lower in mercury.

Best choices

These choices are lower in mercury, so you can eat 8 to 12 ounces a week.

• Canned light tuna
• Catfish
• Cod
• Herring
• Oysters
• Salmon
• Shad
• Shrimp
• Tilapia
• Trout

Good choices

You can eat 4 ounces of these fish a week if you don’t eat any other seafood that week.

• Canned or fresh white (albacore) tuna
• Chilean sea bass or striped bass
• Grouper
• Halibut
• Mahi-mahi
• Snapper
• Yellowfin tuna

Fish to avoid

Don’t eat bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish, or tilefish. They are high in mercury.

Don’t eat certain foods.

These foods may have bacteria in them that can hurt your baby. Stay away from:

• Raw (uncooked) or rare (undercooked) fish or shellfish, like sushi or oysters
• Soft cheeses (like feta, Brie, and goat cheese), unless they are pasteurized
• Raw or rare (undercooked) meats, poultry, or eggs
• Unpasteurized juices or milk
• Lunch or deli meats, smoked seafood, and hot dogs – unless they are heated until steaming hot
• Prepared salads like ham salad, chicken salad, or seafood salad
• Raw sprouts, including alfalfa, clover, radish, and mung bean sprouts

Limit drinks with caffeine and added sugars.

• If you drink coffee or tea, choose decaf. Pick unsweetened options and don’t add sugar.
• Drink water or seltzer instead of drinks with added sugars like soda, fruit drinks, and energy or sports drinks.

Don’t drink alcohol.

No amount of alcohol is safe during pregnancy.

How much should I eat?

Eating healthy foods and the right amount of calories helps you and your baby gain the proper amount of weight.

How much food you need depends on things like your weight before pregnancy, your age, and how fast you gain weight. If you’re at a healthy weight, the Centers for Disease Control and Prevention (CDC) says you need no extra calories in your first trimester, about 340 extra calories a day in your second trimester, and about 450 extra calories a day in your third trimester. You also may not need extra calories during the final weeks of pregnancy.

Check with your doctor about this. If you are not gaining the right amount of weight, your doctor may advise you to eat more calories. If you are gaining too much weight, you may need to cut down on calories. Each woman's needs are different. Your needs depend on if you were underweight, overweight, or obese before you became pregnant, or if you are having more than one baby.

What kinds of foods and beverages should I consume?

A healthy eating plan for pregnancy includes nutrient-rich foods and beverages. The 2015–2020 Dietary Guidelines for Americans recommend these foods and beverages each day

• fruits and vegetables (provide vitamins and fiber)
• whole grains, such as oatmeal, whole-grain bread, and brown rice (provide fiber, B vitamins, and other needed nutrients)
• fat-free or low-fat milk and milk products or nondairy soy, almond, rice, or other drinks with added calcium and vitamin D
• protein from healthy sources, such as beans and peas, eggs, lean meats, seafood that is low in mercury (up to 12 ounces per week), and unsalted nuts and seeds, if you can tolerate them and aren’t allergic to them.

A healthy eating plan also limits salt, solid fats (like butter, lard, and shortening), and sugar-sweetened drinks and foods.

Does your eating plan measure up? How can you improve your eating habits? Try eating fruit like berries or a banana with low-fat yogurt for breakfast, a salad with beans for lunch, and a lean chicken breast and steamed veggies for dinner. Think about things you can try. Write down your ideas in the space below and share them with your doctor.

What if I’m a vegetarian?

A vegetarian eating plan during pregnancy can be healthy. Consider the quality of your eating plan and talk to your health care professional to make sure you’re getting enough calcium, iron, protein, vitamin B12, vitamin D, and other needed nutrients. Your health care professional may also tell you to take vitamins and minerals that will help you meet your needs.

Do I have any special nutrition needs now that I am pregnant?

Yes. During pregnancy, you need more vitamins and minerals such as folate, iron, and calcium.

Getting the appropriate amount of folate is very important. Folate, a B vitamin also known as folic acid, may help prevent birth defects. Before pregnancy, you need 400 mcg per day from supplements or fortified foods, in addition to the folate you get naturally from foods and beverages. During pregnancy, you need 600 mcg. While breastfeeding, you need 500 mcg of folate per day. Foods high in folate include orange juice, strawberries, spinach, broccoli, beans, fortified breads, and fortified low-sugar breakfast cereals. These foods may even provide 100% of the daily value of folic acid per serving.

Most health care professionals tell women who are pregnant to take a prenatal vitamin every day and consume healthy foods, snacks, and beverages. Ask your doctor about what you should take.

What other new habits may help my weight gain?

Pregnancy can create some new food, beverage, and eating concerns. Meet the needs of your body and be more comfortable with these tips. Check with your health care professional with any concerns.

• Eat breakfast every day. If you feel sick to your stomach in the morning, try dry whole-wheat toast or whole-grain crackers when you first wake up. Eat them even before you get out of bed. Eat the rest of your breakfast (fruit, oatmeal, hot or cold cereal, or other foods) later in the morning.
• Eat high-fiber foods. Eating high-fiber foods, drinking water, and getting daily physical activity may help prevent constipation. Try to eat whole-grain cereals, brown rice, vegetables, fruits, and beans.
• If you have heartburn, eat small meals spread throughout the day. Try to eat slowly and avoid spicy and fatty foods (such as hot peppers or fried chicken). Have drinks between meals instead of with meals. Don’t lie down soon after eating.

What foods and drinks should I avoid?

Certain foods and drinks can harm your baby if you have them while you’re pregnant. Here’s a list of items you should avoid.

• Alcohol. Do not drink alcohol, such as wine, beer, or hard liquor.
• Caffeine. Enjoy decaf coffee or tea, drinks not sweetened with sugar, or water with a dash of juice. Avoid diet drinks, and limit drinks with caffeine to less than 200 mg per day—the amount in about 12 ounces of coffee.
• Fish that may have high levels of mercury (a substance that can build up in fish and harm an unborn baby). Limit white (albacore) tuna to 6 ounces per week. Do not eat king mackerel, marlin, orange roughy, shark, swordfish, or tilefish. To get the helpful nutrients in fish and shellfish, you may eat up to 12 ounces of seafood per week, choosing from many safe seafood choices, such as cod, salmon, and shrimp.
• Foods that may cause illness in you or your baby (from viruses, parasites, or bacteria such as Listeria or E. coli). Avoid soft cheeses made from unpasteurized or raw milk; raw cookie dough; undercooked meats, eggs, and seafood; and deli salads. Take care in choosing and preparing lunch meats, egg dishes, and meat spreads.
• Anything that is not food. Some pregnant women may crave something that is not food, such as laundry starch, clay, ashes, or paint chips. This may mean that you’re not getting the right amount of a nutrient. Talk to your health care professional if you crave something that isn’t food. He or she can help you get the right amount of nutrients.

During pregnancy, you should avoid:

• Alcohol. There is no known amount of alcohol that is safe for a woman to drink during pregnancy.
• Fish that may have high levels of mercury. Limit white (albacore) tuna to 6 ounces per week. Do not eat tilefish, shark, swordfish, marlin, orange roughy, or king mackerel.
• Foods that are more likely to contain germs that could cause foodborne illness, including
  • Refrigerated smoked seafood like whitefish, salmon, and mackerel
  • Undercooked meat, poultry, eggs, and seafood
  • Refrigerated meat spreads
  • Store-made salads, such as chicken, egg, or tuna salad
  • Unpasteurized or raw milk
  • Unpasteurized juices or cider
  • Unpasteurized soft cheeses, such as unpasteurized feta, Brie, queso blanco, queso fresco, and blue cheeses
  • Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)
  • Raw cookie dough
  • Unwashed fruits and vegetables
• Too much caffeine. Drinking high amounts of caffeine may be harmful for your baby. For most people, it's best to limit caffeine to less than 200 mg per day during pregnancy. But first check with your provider about whether you should have caffeine at all.

What is foodborne illness?

• It's a sickness that occurs when people eat or drink harmful microorganisms (bacteria, parasites, viruses) or chemical contaminants found in some foods or drinking water.
• Symptoms vary, but may include: stomach pain, vomiting, diarrhea, fever, headache, or body aches. Sometimes you may not feel sick, but whether you feel sick or not, you can still pass the illness to your unborn child without even knowing it.

Why are pregnant women at high risk?

• You and your growing fetus are at high risk from some foodborne illnesses because during pregnancy your immune system is altered, which makes it harder for your body to fight off certain harmful foodborne microorganisms.
• Your unborn baby's immune system is not developed enough to fight off harmful foodborne microorganisms.
• For both mother and baby, foodborne illness can cause serious health problems - or even death.

4 Simple Steps to Keep You and Your Baby Healthy

There are many bacteria that can cause foodborne illness, such as E. coli O157:H7 and Salmonella. Here are 4 Simple Steps you should follow to keep yourself and your baby healthy during pregnancy and beyond!

1. Clean

• Wash hands thoroughly with warm water and soap.
• Wash hands before and after handling food, and after using the bathroom, changing diapers, or handling pets.
• Wash cutting boards, dishes, utensils, and countertops with hot water and soap.
• Rinse raw fruits and vegetables thoroughly under running water.

2. Separate

• Separate raw meat, poultry, and seafood from ready-to-eat foods.
• If possible, use one cutting board for raw meat, poultry, and seafood and another one for fresh fruits and vegetables.
• Place cooked food on a clean plate. If cooked food is placed on an unwashed plate that held raw meat, poultry, or seafood, bacteria from the raw food could contaminate the cooked food.

3. Cook

• Cook foods thoroughly. Use a food thermometer to check the temperature.
• Keep foods out of the Danger Zone: The range of temperatures at which bacteria can grow - usually between 40° F and 140° F (4° C and 60° C).
• 2-Hour Rule: Discard foods left out at room temperature for more than 2 hours. When temperatures are above 90° F (32° C), discard food after 1 hour.

4. Chill

• Your refrigerator should register at 40° F (4° C) or below and the freezer at 0° F (-18° C). Place an appliance thermometer in the refrigerator, and check the temperature periodically.
• Refrigerate or freeze perishables (foods that can spoil or become contaminated by bacteria if left unrefrigerated).
• Use ready-to-eat, perishable foods (dairy, meat, poultry, seafood, produce) as soon as possible.

2 Foodborne Risks for Pregnant Women

As a mom-to-be, there are 2 specific foodborne risks that you need to be aware of. These risks can cause serious illness or death to you or your unborn child. Follow these steps to help ensure a healthy pregnancy.

1. Listeria monocytogenes

What it is: A harmful bacterium that can grow at refrigerator temperatures where most other foodborne bacteria do not. It causes an illness called listeriosis.

Where it's found: Refrigerated, ready-to-eat foods and unpasteurized milk and milk products.

How to prevent illness:

• Follow the 4 Simple Steps above.
• Do not eat hot dogs and luncheon meats - unless they're reheated until steaming hot.
• Do not eat soft cheese, such as Feta, Brie, Camembert, "blue-veined cheeses," "queso blanco," "queso fresco," and Panela - unless it's labeled as made with pasteurized milk. Check the label.
• Do not eat refrigerated pâtés or meat spreads.
• Do not eat refrigerated smoked seafood - unless it's in a cooked dish, such as a casserole. (Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." These types of fish are found in the refrigerator section or sold at deli counters of grocery stores and delicatessens.)
• Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk.

2. Toxoplasma gondii

What it is: A harmful parasite. It causes an illness called toxoplasmosis that can be difficult to detect.

Where it's found: Raw and undercooked meat; unwashed fruits and vegetables; contaminated water, soil; dirty cat-litter boxes; and outdoor places where cat feces can be found.

How to prevent illness:

• Follow the 4 Simple Steps above.
• If possible, have someone else change the litter box. If you have to clean it, wash your hands with soap and warm water afterwards.
• Wear gloves when gardening or handling sand from a sandbox.
• Don't get a new cat while pregnant.
• Cook meat thoroughly.

Welcome to Safe Eats, your food-by-food guide to selecting, preparing, and handling foods safely throughout your pregnancy and beyond!

Protein in meat, poultry, and seafood is an important nutrient in your diet, but it can also be an ideal environment for some harmful bacteria. Here's how to keep harmful bacteria at bay and your family safe.

Clean Is Key!

Your first steps in food safety are...

• Wash hands thoroughly with warm water and soap before and after handling raw meat, poultry, and seafood.
• Wash cutting boards, dishes, and utensils (including knives), and countertops with soap and hot water after they come in contact with raw meat, poultry or seafood.

Sanitize It!

Kitchen countertops that come in contact with raw meat, poultry, and seafood can be sanitized using a kitchen sanitizer. One teaspoon of liquid chlorine bleach per quart of clean water can also be used to sanitize surfaces. Leave the bleach solution on the surface for about 10 minutes to be effective.

S-E-P-A-R-A-T-E

Improper handling of raw meat, poultry, and seafood can set the stage for cross-contamination - the spread of bacteria from foods, hands, utensils, and food preparation surfaces to another food. Here's how to stop it:

• Separate raw meat, poultry, and seafood from ready-to-eat foods in your grocery shopping cart, refrigerator, and while preparing and handling foods at home. Also, consider placing these raw foods inside plastic bags in your grocery shopping cart to keep the juices contained.
• To prevent juices from raw meat, poultry, or seafood from dripping onto other foods in the refrigerator, place these raw foods in sealed containers or sealable plastic bags.
• If possible, use one cutting board for raw meat, poultry, and seafood and another one for fresh fruits and vegetables. If two cutting boards aren't available, prepare fruits and vegetables first, and put them safely out of the way. Wash the cutting board thoroughly with soap and hot water. Then, prepare the raw meat, poultry, or seafood. Follow by washing the cutting board again.
• Marinades used on raw meat, poultry, or seafood can contain harmful bacteria. Don't reuse these marinades on cooked foods - unless you boil them before applying.
• Never taste uncooked marinade or sauce that was used to marinate raw meat, poultry, or seafood.
• Place cooked food on a clean plate for serving. If cooked food is placed on an unwashed plate that previously held raw meat, poultry, or seafood, bacteria from the raw food could contaminate the cooked food.

CHILL!

To keep all meats, poultry, and food in general safe...

• Your refrigerator should register at 40° F (4° C) and the freezer at 0° F (-18° C). Place a refrigerator thermometer in the refrigerator, and check the temperature periodically. During the automatic defrost cycle, the temperature may temporarily register slightly higher than 40° F (4° C). This is okay.

When storing seafood...

• Buy only fresh seafood that's refrigerated or properly iced.
• Refrigerate or freeze seafood immediately if you're not going to cook it right away.

Moms-to-Be: Advice About Eating Fish

Due to the evidence of benefits from eating fish, women who are pregnant or breastfeeding should consume at least 8 and up to 12 ounces per week of a variety of fish, from choices that are lower in methylmercury.

Choices to Avoid
Highest Mercury Levels

• King mackerel
• Marlin
• Orange roughy
• Shark
• Swordfish
• Tliefish (Gulf of Mexico)
• Tuna, bigeye

Pre-stuffed Poultry: Fresh Vs. Frozen

• Avoid purchasing fresh, raw whole poultry that's been pre-stuffed. The raw-meat juices mixing with the stuffing can cause bacterial growth.
• Frozen, raw whole poultry that's been pre-stuffed is safe and should be cooked in its frozen state; don't defrost it first.

COOK IT RIGHT!

Raw fish (such as sushi or sashimi) or foods made with raw fish are more likely to contain parasites or bacteria than foods made from cooked fish, so it's important to cook fish thoroughly. Here's how...

Seafood

Finfish should be cooked to an internal temperature of 145° F (63° C). When a food thermometer is not available or appropriate, follow these tips to determine when seafood is done:

• Cook fish until it's opaque (milky white) and flakes with a fork.
• Cook shrimp, lobster, and scallops until they reach their appropriate color. The flesh of shrimp and lobster should be an opaque (milky white) color. Scallops should be opaque (milky white) and firm.
• Cook clams, mussels, and oysters until their shells open. This means that they are done. Throw away the ones that didn't open.
• Shucked clams and shucked oysters are fully cooked when they are opaque (milky white) and firm.

Eating Raw Seafood Is Risky - A pregnant woman and her unborn baby are at risk if she eats raw or undercooked seafood. Moms-to-be should avoid eating raw or undercooked finfish or shellfish (including oysters, clams, mussels, and scallops).

Meat/Poultry

Cook raw meat and poultry to safe internal temperatures. Always use a clean food thermometer to check the internal temperature of these foods. Make sure it goes straight into meats, but doesn't come out the other side and touch the pan. Cook meat and poultry to these temperatures:

Meat

Cook beef, pork, veal, and lamb roasts, steaks, and chops to at least 145° F (63° C), with a 3 minute rest time.

Ground Meat

Cook ground beef, veal, lamb, and pork to at least 160° F (71° C).

Cook ground poultry to 165° F (74° C).

Poultry

Cook all poultry to minimal safe internal temperature of 165° F (74° C).

Consumers may wish to cook poultry to a higher temperature for personal preference.

Questions and Answers

"How can I tell if fish is fresh?"

Perfectly fresh fish and shellfish have virtually no odor. It's only when seafood starts to spoil that it takes on a "fishy" aroma. Fresh fish will have these signs:

• The eyes are clean and bulge a little.
• Whole fish and fillets have firm and shiny flesh and bright, red gills free from slime.
• The flesh springs back when pressed.
• There is no darkening around the edges or brown or yellowish discoloration.
• The fish smells fresh and mild, not "fishy" or ammonia-like.

Note: Keep in mind that just because fish is fresh doesn't mean it's bacteria-free. You still need to follow the food safety tips above when handling or preparing fresh fish.

"What should I look out for when buying frozen seafood?"

You should follow these guidelines:

• Don't buy frozen seafood if its package is open, torn, or crushed on the edges.
• Don't buy packages that are above the frost line in the store's freezer.
• If you can see through the package, look for signs of frost or ice crystals, which could mean the fish has been stored a long time or defrosted and refrozen. In this case, you shouldn't buy it.
• There should be no white spots, dark spots, discoloration or fading, or red or pink flesh to indicate drying-out.

"Some of my favorite seafoods are raw clams and oysters. Why aren't they safe to eat?"

They're unsafe because raw seafoods are more likely to contain parasites or bacteria than foods made from cooked seafood. In addition, clams, mussels, and other mollusks get their food by filtering large quantities of water through their shells. In doing so, they can accumulate more bacteria and viruses than finfish. This makes raw mollusks particularly unsafe to eat. Seafood that's been cooked thoroughly is safe to eat.

"Should I stop marinating meat, poultry, and seafood at room temperature while I'm pregnant?"

Actually, you should discontinue this practice whether you're pregnant or not. Marinade that's been used on raw meat, poultry, and seafood contains raw juices, which may contain harmful bacteria. And, bacteria grow rapidly at room temperature. Refrigeration slows bacterial growth, so for your safety, foods should always be refrigerated while marinating.

Welcome to Safe Eats, your food-by-food guide to selecting, preparing, and handling foods safely throughout your pregnancy and beyond!

Dairy and eggs are an important part of a healthy diet. Careful handling of these foods will help prevent foodborne illness. Here's how to do it...

Eggs-tra Care for Eggs...

Some raw eggs can be contaminated with harmful bacteria. Here are some egg safety tips:

• Cook eggs thoroughly until the yolks and whites are firm.
• Cook scrambled eggs until they're firm throughout.
• Cook fried eggs for 2 to 3 minutes on each side, or cook 4 minutes in a covered pan.
• Avoid eating or tasting foods that may contain raw or lightly-cooked eggs, such as:
  • Raw batter, filling, or cookie dough made with raw eggs
  • Eggnog and other egg-fortified beverages that are not thoroughly cooked
  • Homemade and fresh-made dressings and sauces made with raw eggs -
    • Caesar salad dressing
    • Béarnaise sauce
    • Hollandaise sauce
    • Aioli sauce
    • Homemade mayonnaise
  • Homemade ice cream
  • Mousse
  • Meringue
  • Tiramisu

Note: Commercial mayonnaise, dressing, and sauces contain pasteurized eggs that are safe to eat.

Safe Ways to Make Your Favorite Egg-containing Foods!

• Use store-bought products of the foods listed above, which are often already cooked or pasteurized.
• Make recipes that call for raw eggs safer by adding the eggs to the amount of liquid called for in the recipe, then heating the mixture thoroughly.
• Purchase pasteurized eggs. These eggs can be found in some supermarkets and are labeled "pasteurized." Here are several types consumers can buy:
  • Fresh, pasteurized eggs in the shell (found in the refrigerator section)
  • Liquid, pasteurized egg products (found in the refrigerator section)
  • Frozen, pasteurized egg products (found in the frozen food section)
  • Powdered egg whites (found in the baking section)

The Chill Factor

Cold temperatures keep most harmful bacteria from multiplying, so to prevent the growth of bacteria, keep milk and milk products refrigerated at 40° F (4° C) and follow expiration and "use-by" dates on products.

Be Sure Dairy is Pasteurized!

All milk sold in interstate commerce is pasteurized (heat-processed to kill harmful bacteria). However, other dairy products, such as some cheeses, are not necessarily made with pasteurized milk. These products may be produced and sold locally, such as on dairy farms or local cheese stores. Be sure that all the dairy products you consume are made with pasteurized milk. Check the label.

Moms-to-Be: Watch Out for Listeria monocytogenes
Listeria monocytogenes is a bacterium that can be found in unpasteurized milk and cheese made from unpasteurized milk. It can be particularly harmful to you and your unborn baby.

Smart Talk....

"I haven't heard about pasteurized eggs in the shell until now. What are they and where can I get them?"
Today, some manufacturers are pasteurizing eggs in the shell. Eggs in the shell are heated to a temperature that kills bacteria, but doesn't cook the eggs. Pasteurized eggs in the shell can be found in the refrigerator section of some supermarkets. Read the label to check.

"I've tasted cake batter from a mixing bowl since I was a child. Why is it an issue now?"The issue is Salmonella Enteritidis, a harmful bacterium that can be found in raw eggs. Tasting raw cookie dough or raw cake batter than contains raw eggs is risky. The U.S. Centers for Disease Control and Prevention estimate that one egg in 20,000 may be contaminated. Although the number of eggs affected is small, there have been cases of foodborne illness caused by contaminated eggs. To be safe, avoid tasting raw batter, filling, or raw cookie dough that contains raw eggs.

"Is store-bought cookie dough ice cream safe to eat?"
Yes, it's made from specially-produced cookie dough that's pasteurized, so eat on!

"I love 'queso fresco,' a Mexican-style cheese, but it's often made with unpasteurized milk. Is there a way to make it safely?"
If you enjoy making your own cheeses at home, be sure to use pasteurized milk.

Fresh fruits, veggies, and juices taste good and are good for you. Careful selection and handling of these foods will prevent foodborne illness. Follow these tips to be safe.

Wash those Fruits and Veggies!

Raw fruits and vegetables can become contaminated with harmful bacteria. Here's the proper way to prepare and handle them safely:

• Thoroughly rinse raw fruits and vegetables under running water before eating or preparing them, especially fruits that require peeling or cutting - like cantaloupe and other melons. Bacteria can be found on the outer rind or peel.
• Don't use soap, detergents, or bleach solutions to wash produce.
• As an added precaution, use a small vegetable brush to remove surface dirt.
• Try to cut away damaged or bruised areas - bacteria can thrive in these places.

Pregnant Women Be Aware!

Toxoplasma, a parasite that can be found on unwashed fruits and vegetables, can be particularly harmful to a mom-to-be and her unborn baby.

The Sprout Issue

Bacteria can get into sprout seeds through cracks in the shell before the sprouts are grown. Once this occurs, these bacteria are nearly impossible to wash out. Sprouts grown in the home are also risky if eaten raw. Many outbreaks have been linked to contaminated seed. If pathogenic bacteria are present in or on the seed, they can grow to high levels during sprouting - even under clean conditions. To reduce the risk:

• Avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean).
• Cook sprouts thoroughly. This significantly reduces the risk of illness.
• Check sandwiches and salads purchased at restaurants and delicatessens. They may often contain raw sprouts. Request that raw sprouts not be added to your food.

Juicy TIPS...

When fruits and vegetables are peeled, cut, or fresh-squeezed, harmful bacteria that may be on the outside can spread to the inside of the produce. To prevent foodborne illness, only drink those juices that have been pasteurized or otherwise treated to kill harmful bacteria. Read the label! Also, remember to thoroughly rinse raw fruits and vegetables under running water before eating or preparing them at home.

Pasteurized Juice: Where to Find It

Pasteurized or Shelf-stable Juice

Pasteurized juice can be found in the refrigerated or frozen juice sections of stores. Like milk, pasteurized juice must be refrigerated or frozen.

Shelf-stable juice is able to be stored unrefrigerated on the shelf and is normally found in the non-refrigerated juice section of stores. It's packaged in treated containers, such as boxes, bottles, or cans.

Unpasteurized or Untreated Juice

These are normally found in the refrigerated sections of grocery stores, health-food stores, cider mills, or farm markets. Such juices must have this warning on the label:

WARNING: This product has not been pasteurized and therefore may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems.

Note

Juices that are fresh-squeezed and sold by the glass, such as at farmer's markets, at roadside stands, or in some juice bars, may not be pasteurized, or otherwise treated to ensure their safety. Warning labels are not required on these products. Pregnant women and young children should avoid these juices.

If you can't tell if a juice has been processed to destroy harmful bacteria, either don't use the product or boil it to kill any harmful bacteria.

Smart Talk...

"I never read the labels on juice. Isn't all juice pasteurized?" Ninety-eight percent of the juice sold in the U.S. is pasteurized (heat is applied to the juice to kill harmful bacteria). The remaining 2% of juice is unpasteurized and may contain harmful bacteria. For your safety and that of your baby, always read the labels to make sure juice is pasteurized.

"I love 'smoothies'! Are they safe to drink while I'm pregnant?" There have been foodborne illness outbreaks associated with drinking "smoothies" (blended fruit drinks) made with unpasteurized juice. "Smoothies" made with pasteurized juice are safe to drink. If you're making "smoothies" at home or ordering one from a restaurant, make sure it's made with pasteurized juice. Also, if you're using fresh fruits, be sure to wash them thoroughly under running water.

"I thought the acid in juice would kill any bacteria that might be present. Is this not true?" No, acid doesn't always kill bacteria, often it only slows or stops bacterial growth. Plus, there are some bacteria that are very resistant to acid. For example, E. coli O157:H7 can survive in acidic juices, like orange or apple, for a long time.

Protecting you and your unborn baby from Listeria monocytogenes just takes following these careful food selection and preparation tips.

Tips for Moms-to-Be

What Is It?Listeria monocytogenes is a bacterium that can be found in ready-to-eat, perishable foods such as dairy, meat, poultry, and seafood. It's unusual because it can grow at refrigerator temperatures where most other foodborne bacteria do not. It can also be particularly harmful to you and your unborn baby.

Check Time and Temperatures

• Your refrigerator should register at 40° F (4° C) or below and the freezer at 0° F (-18° C). Place a refrigerator thermometer in the refrigerator, and check the temperature periodically. During the automatic defrost cycle, the temperature may register slightly higher than 40° F. This is okay.
• Refrigerate or freeze perishables, prepared food, and leftovers within two hours of eating or preparation. Follow the 2-Hour Rule: Discard food that's left out at room temperature for longer than two hours. When temperatures are above 90° F (32° C), discard food after one hour.
• Use ready-to-eat, perishable foods, such as dairy, meat, poultry, seafood, and produce, as soon as possible.

Clean the Fridge

• Clean your refrigerator regularly.
• Wipe up spills immediately.
• Clean the inside walls and shelves with hot water and a mild liquid dishwashing detergent; then rinse.
• Once a week, check expiration and "use by" dates, and throw out foods if the date has passed. Follow the recommended storage times for foods.

To Eat or Not to Eat?

Don't eat:

• Hot dogs, deli meats, and luncheon meats - unless they're reheated until steaming hot.
• Soft cheeses like Feta, Brie, and Camembert, "blue-veined cheeses," or "queso blanco," "queso fresco," or Panela - unless they're made with pasteurized milk. Make sure the label says, "made with pasteurized milk."
• Refrigerated pâtés or meat spreads.
• Refrigerated smoked seafood - unless it's in a cooked dish, such as a casserole. (Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." These types of fish are found in the refrigerator section or sold at deli counters of grocery stores and delicatessens.)
• Raw (unpasteurized) milk or foods that contain unpasteurized milk.

It's okay to eat:

• Canned or shelf-stable (able to be stored unrefrigerated on the shelf) pbtés and meat spreads.
• Canned or shelf-stable smoked seafood.
• Pasteurized milk or foods that contain pasteurized milk.

"I've heard about Listeria monocytogenes in relation to pregnancy. What is it that makes this bacterium more harmful to me and my baby than other foodborne bacteria?"
All foodborne bacteria can pose a risk to pregnant women and people in general, so it's important for everyone to always follow good food safety practices. But, because a pregnant woman's immune system is constantly changing during these nine months, certain foodborne pathogens, such as Listeria monocytogenes and Toxoplasma gondii (a parasite that can be found in raw or undercooked pork, lamb, or venison; contaminated water; and cat litter) and methylmercury (a metal found in some fish and shellfish), are more effective in crossing the placenta into the fetus than other foodborne pathogens.
These risks often don't make the mother feel very sick, but can have a severe effect on her unborn baby. The good news is... they're easy to prevent!

"Does the temperature of my refrigerator really matter in helping reduce the growth of Listeria monocytogenes?"
Yes, making sure that the inside temperature of your refrigerator registers at 40: F (4: C) is really important! Listeria monocytogenes can grow at refrigerator temperatures, but at 40: F (4: C) or below, it grows more slowly. Remember, the more bacteria there are, the greater the chances for foodborne illness. Plus, using ready-to-eat, perishable foods as soon as possible means that Listeria monocytogenes has less time to grow. And, be sure to follow the guidelines above for cleaning your refrigerator. This will also help keep Listeria monocytogenes at bay!

"I've read about food recalls in the news involving Listeria monocytogenes. What should I do if I have food that's recalled because of Listeria monocytogenes?"
Don't eat any food that's recalled and removed from grocery store shelves. Always return recalled food to the place where you bought it.

When you eat out, look at your surroundings before you even sit down. If it's not clean, you should consider eating somewhere else. Also, make sure you wash your hands with soap and warm water before eating. If soap and water aren't available, use alcohol-based wipes or gel formulas to clean your hands.

Make a Clean Start

Waiting at a restaurant, cafeteria, or a fast food place can be an enjoyable experience. But, because you're pregnant, you need to take special care that the food served to you is safe. During pregnancy, your immune system is weakened, which makes it harder for your body to fight off harmful foodborne microorganisms that cause foodborne illness. Here's how to stay safe.

What's On the Menu?

When dining out: Remember that harmful bacteria can be hidden in some foods on the menu, so pay close attention to the type of food it is and how it's prepared.

Cook Thoroughly: Please always request that your food be cooked thoroughly, especially meat, poultry, fish, and eggs. When a hot meal is served, make sure it's piping hot and thoroughly cooked. If it's lukewarm, send it back.

Eating It Raw is Risky: Raw fish (such as sushi or sashimi) or foods made with raw fish are more likely to contain parasites or bacteria than foods made from cooked fish. Don't eat raw or undercooked finfish or shellfish (including oysters, clams, and mussels).

Moms-to-Be: Don't Order These

King mackerel, marlin, orange roughy, shark, swordfish, tilefish (from the Gulf of Mexico), and bigeye tuna. These fish can contain high levels of methylmercury, an element that can be harmful to your unborn baby. Due to the evidence of benefits from eating fish, women who are pregnant or breastfeeding should consume at least 8 and up to 12 ounces per week of a variety of fish, from choices that are lower in methylmercury.

Raw sprouts of any kind (including alfalfa, clover, and radish). Bacteria can get into the sprout seeds through cracks in the shell before the sprouts are grown. Once this occurs, these bacteria are nearly impossible to wash out. Check sandwiches and salads. They may often contain raw sprouts. Request that raw sprouts not be added to your food.

Juice by the glass. Juices that are fresh squeezed and sold by the glass, at some juice bars, for example, may not be pasteurized or otherwise treated to ensure their safety. Warning labels are not required on these products. Pregnant women and young children should avoid all unpasteurized juices.

Harmful bacteria can be found in raw or undercooked eggs. Some restaurants may use uncooked eggs in foods like Caesar salad dressing, custards, and some sauces. Avoid foods that might contain raw or undercooked eggs.

If you're unsure about the ingredients in a particular dish, ask your server before ordering it.

Bringing In

With meal portions getting bigger, more and more people are packing the doggie bag with leftovers to enjoy later. Take care to handle leftovers, take-out, and delivered foods safely.

Leaving A Restaurant With A Doggie Bag?

Handle the leftovers with care. If you won't be arriving home within 2 hours of being served, don't take the leftovers home with you. And, remember that the inside of a car can get very warm, and bacteria can grow rapidly in foods if they're left in these conditions. To be safe, it's best to go directly home after eating out and put your leftovers in the refrigerator as soon as you arrive.

A Note About Take-Out Foods

When hot, cooked food is purchased, get the food home quickly and eat it right away. Don't let it sit out at room temperature. Cold foods should be eaten within 2 hours of preparation. Otherwise, store it in the refrigerator or freeze it for eating at another time.

Special Delivery

For delivered foods, eat the food within 2 hours after it arrives to prevent harmful bacteria from multiplying. If the food is not going to be eaten within two hours, you can keep it hot in the oven with the temperature set at or above 200° F (93° C). Side dishes, like stuffing, must also be kept hot in the oven. Covering food will help keep it moist while you keep it warm. Check with a food thermometer to make sure that the food is held at an internal temperature of 140° F (60° C).

The Danger Zone: The "danger zone" is the range of temperatures at which bacteria can grow - usually between 40° and 140° F (4° and 60° C). For food safety, it's important to keep food below or above the "danger zone."

Remember the 2-Hour Rule: Discard any perishables (foods that can spoil or become contaminated by bacteria if unrefrigerated) left out at room temperature for longer than 2 hours. When temperatures are above 90° F (32° C), discard food after 1 hour.

You may be surprised to learn that there is arsenic in rice.

In fact, rice is not the only food or beverage that contains arsenic. It’s also found in vegetables, fruits, and many other foods. The FDA has been monitoring the presence of arsenic in food as part of its ongoing oversight of the safety of the food supply. And now we’ve looked at arsenic in infant rice cereal.

Let’s start at the beginning.

1. How does arsenic get in your food?

Arsenic is an element in the Earth’s crust and is present in very small amounts in water, soil and air. Crops absorb arsenic as they grow. That’s how it gets into foods and beverages — it’s not an additive or ingredient — and it cannot be completely eliminated.

There are two forms of arsenic, organic and inorganic, with inorganic being the more toxic. The term “organic” in this case has nothing to do with types of farming. It’s about chemical elements. If arsenic atoms bond with carbon, the compound is organic. If there’s no carbon present, it’s inorganic.

2. What about arsenic in rice?

Rice is a staple of the global diet, and is also a leading dietary source of inorganic arsenic. This is because of how commonly it’s consumed and because as rice plants grow, the plant and grain tend to absorb arsenic more readily than other food crops.

This, in part, is what led us to look more closely at arsenic in rice. In 2013, FDA released test data for the levels of inorganic arsenic in most types of rice grain and rice-based foods and beverages consumed in the United States. The agency tested about 1,300 samples of rice and rice products in all.

The FDA continued to test for inorganic arsenic in infant rice cereals in 2014 and 2018.

Testing was expanded to include infant rice cereal because, relative to body weight, infants consume about three times more rice than adults, primarily through infant rice cereal. In fact, data show that infants consume the most rice, relative to their weight, at 8 months of age primarily because rice cereal is commonly a major component of an infant’s diet.

In 2020, the agency released final guidance for industry on an action level of 100 parts per billion inorganic arsenic in infant rice cereal. The testing results show that over time there has been a steady increase in the number of samples that are below that level. Results from sampling in 2018 show that 76% of samples were at or below the 100 ppb level, compared to 47% of samples tested in 2014 and 36% of samples tested between 2011-2013.

3. What are the potential health effects?

It has long been known that arsenic is a carcinogen. However, more recently, concerns have been raised about potential developmental effects on infants and adverse pregnancy outcomes.

In addition to extensive testing, FDA has completed a thorough analysis of a growing body of scientific studies linking adverse pregnancy outcomes to intake of relatively high levels of inorganic arsenic during pregnancy. The agency also found that exposure may result in a child’s decreased performance on certain developmental tests that measure learning.

Related to cancer, FDA estimated that exposure to inorganic arsenic in rice and rice products causes an additional four cases of lung and bladder cancer over the lifetime for every 100,000 people in the United States. This estimate would account for far less than 1 percent of the nation’s lung and bladder cancer cases.

4. What is FDA doing in light of its findings?

In 2020, the FDA issued final guidance to industry that includes a maximum recommended amount, or "action level," of 100 parts per billion inorganic arsenic in infant rice cereal. (Of note, the European Commission established the same level for rice intended for the production of food for infants and young children.) FDA testing found that the majority of infant rice cereal currently on the market either meets, or is close to, the action level.

What FDA is asking food manufacturers to do will reduce the exposure for infants and, based on our testing, the agency believes this is feasible for the companies. In 2018, the FDA tested 149 samples of infant rice cereals on the market and found 76% already meet the action level.

This is not the first time the federal government has limited arsenic in foods or beverages. The EPA has set a limit for arsenic in drinking water, and the FDA has already set an allowable level of 10 ppb arsenic in bottled water and proposed an action level of 10 ppb inorganic arsenic for apple juice.

5. If you have an infant or are pregnant, what should you do?

Based on the FDA’s findings with respect to inorganic arsenic in rice, the agency offers the following advice to parents and caregivers of infants. It is consistent with advice given by the American Academy of Pediatrics.

• Feed your baby iron-fortified cereals to be sure she or he is receiving enough of this important nutrient.
• Rice cereal fortified with iron is a good source of nutrients for your baby, but it shouldn’t be the only source, and does not need to be the first source. Other fortified infant cereals include oat, barley and multigrain.
• For toddlers, provide a well-balanced diet, which includes a variety of grains.

Also based on the FDA’s findings, it would be prudent for pregnant women to consume a variety of foods, including varied grains (such as wheat, oats, and barley), for good nutrition.

Published studies, including new research by the FDA, indicate that cooking rice in excess water (from six to 10 parts water to one part rice), and draining the excess water, can reduce from 40 to 60 percent of the inorganic arsenic content, depending on the type of rice — although this method may also remove some key nutrients.

6. If you’re an adult, what should you do?

The FDA did not find a scientific or public health basis to recommend that the general population of consumers change its rice consumption based on the presence of arsenic.

But the agency’s general advice about eating a well-balanced diet that’s not based on any one food extends to all consumers, including toddlers, older children and adults. Eating a variety of foods is more nutritious and if there are substances in food (like arsenic) where reducing exposure is prudent, you’re minimizing that exposure.

7. Is it ok for me to eat rice and give it to my children?

Consumers can certainly eat rice as part of a well-balanced diet. Based on our scientific assessment, we think it would be prudent for parents and caregivers to feed their infants a variety of fortified infant cereals, rather than to rely solely on infant rice cereal. We also encourage pregnant women to eat a variety of foods, including varied grains.

For most people, the risk from eating contaminated fish and shellfish is not a health concern. However, some groups of people such as pregnant women, children and the elderly are at a greater health risk than others. Additionally, some individuals are at a higher risk simply because they eat substantially more fish than others.

If you are pregnant, a young child, an older adult, or someone with a weakened immune system, to avoid food-borne illness from bacteria (often called “food poisoning”) you are advised not to eat:

• Raw fish, partially cooked seafood (such as shrimp and crab), or refrigerated smoked seafood.
• Raw shellfish (including oysters, clams, mussels, and scallops) or their juices.

For contaminants that can build up in your body over time, like mercury, refer to the applicable high-risk group section.

People who are Pregnant, May Become Pregnant or are Breastfeeding

The nutritional value of fish is important during growth and development before birth, in early infancy for breastfed infants and in childhood. The health risks from mercury in fish and shellfish depend on the amount of fish and shellfish a person eats and the levels of mercury in the specific fish and shellfish. Some fish contain higher levels of mercury that may harm an unborn baby or young child's developing nervous system.

As a result, people who are pregnant or may become pregnant and people who are nursing risk exposing their children to contamination if they eat these fish.

Children

EPA-FDA Advice about Eating Fish: What Pregnant Women and Parents Should Know includes a chart of more than 60 types of fish and shellfish grouped into “best choices,” “good choices” and “choices to avoid.” The advice recommends that children eat 1 to 2 servings of fish each week from the “best choices” list, and in smaller portion sizes than adults:

• 1 to 3 years old should eat 1 ounce per serving
• 4 to 7 years old should eat 2 ounces per serving
• 8 to 10 years old should eat 3 ounces per serving
• 11 and older can eat adult-sized portions of 4 ounces per serving.

Older Adults and People with Underlying Health Conditions

The elderly and those with underlying health conditions may be more susceptible to adverse health effects from contaminated fish even if contamination levels are low.

Both of these groups are at a greater risk to negative health impacts because their bodies may be less able to remove these contaminants safely from their systems. Therefore, these people should limit their consumption of fish and shellfish that may be contaminated.

People Who Eat More Fish Than the Average Person

Eating fish frequently and/or in large quantities can pose a significant health risk because mercury and other contaminants tend to build up in your body over time. This can expose a person to more contamination.

Sport anglers and recreational fishers, as well as subsistence fishers, are at risk because these groups tend to eat more fish than the average person.

These groups should pay particular attention to the types of fish they consume, the amount of fish and the waters that they eat fish from to ensure that they do not put their health at risk. States, territories, and tribes provide advice on fish caught in waters in their jurisdiction. For current advisories visit the relevant fish advisory website.

FDA and EPA have issued advice regarding eating fish.

This advice can help those who might become or are pregnant or breastfeeding as well as parents and caregivers who are feeding children make informed choices when it comes to the types of fish that are nutritious and safe to eat.

Fish provide key nutrients that support a child’s brain development.

Fish are part of a healthy eating pattern and provide key nutrients during pregnancy, breastfeeding, and/or early childhood to support a child’s brain development:

• Omega-3 (called DHA and EPA) and omega-6 fats
• Iron
• Iodine (during pregnancy)
• Choline

Choline also supports development of the baby’s spinal cord. Fish provide iron and zinc to support children’s immune systems. Fish are a source of other nutrients like protein, vitamin B12, vitamin D, and selenium too.

Eating fish can provide other health benefits too.

Fish intake during pregnancy is recommended because moderate scientific evidence shows it can help your baby’s cognitive development.

Strong evidence shows that eating fish, as part of a healthy eating pattern, may have heart health benefits.

Healthy eating patterns that include fish may have other benefits too. Moderate scientific evidence shows that eating patterns relatively higher in fish but also in other foods, including vegetables, fruits, legumes, whole grains, low- or non-fat dairy, lean meats and poultry, nuts, and unsaturated vegetable oils, and lower in red and processed meats, sugar-sweetened foods and beverages, and refined grains are associated with:

• Promotion of bone health – decreases the risk for hip fractures
• Decreases in the risk of becoming overweight or obese
• Decreases in the risk for colon and rectal cancers

A healthy eating pattern consists of choices across all food groups (vegetables, fruits, grains, dairy, and protein foods, which includes fish), eaten in recommended amounts, and within calorie needs. Healthy eating patterns include foods that provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium.

The Dietary Guidelines for Americans recommends eating fish as part of a healthy eating pattern.

The Dietary Guidelines for Americans recommends:

• At least 8 ounces of seafood (less for children) per week based on a 2,000 calorie diet.
• Those who are pregnant or breastfeeding consume between 8 and 12 ounces per week of a variety of seafood from choices that are lower in mercury.

Choose a variety of fish that are lower in mercury.

While it is important to limit mercury in the diets of those who are pregnant or breastfeeding and children, many types of fish are both nutritious and lower in mercury.

This chart can help you choose which fish to eat, and how often to eat them, based on their mercury levels.

What is a serving? As a guide, use the palm of your hand.

Pregnancy and breastfeeding:

• 1 serving is 4 ounces

Eat 2 to 3 servings a week from the "Best Choices" list
(OR 1 serving from the "Good Choices" list).

Childhood:
On average, a serving is about:

• 1 ounce at age 1 to 3
• 2 ounces at age 4 to 7
• 3 ounces at age 8 to 10
• 4 ounces at age 11

Eat 2 servings a week from the “Best Choices” list.

1. Should children eat fish and if so, how much?

Yes. Fish have important nutrients that can help your child’s growth and development. We recommend children eat 2 servings of fish per week from a variety of “Best Choices,” but the portion sizes should be smaller than adult portions and right for your child’s age and body weight. On average, a serving size is about 1 ounce for children ages 1-3 years, 2 ounces for children ages 4-7 years, 3 ounces for children ages 8-10 years, and 4 ounces for children 11 years and older.

For some children, the healthy dietary patterns in the Dietary Guidelines for Americans (Tables A3-1 and A3-2) include more fish than our advice. To consume those higher amounts, children should only be fed fish from the “Best Choices” list that are even lower in mercury – these fish are anchovies, Atlantic mackerel, catfish, clams, crab, crawfish, flounder, haddock, mullet, oysters, plaice, pollock, salmon, sardines, scallops, shad, shrimp, sole, squid, tilapia, trout, and whiting.

2. When can I start giving my child fish?

According to the Dietary Guidelines for Americans, you can introduce nutritious foods like fish to complement human milk or infant formula in your baby’s diet once they are about 6 months of age. Starting around that time, complementary foods are necessary to ensure adequate nutrition and exposure to flavors, textures, and different types of foods. Give your baby age-and developmentally-appropriate foods to help prevent choking (advice from CDC and USDA). Signs that your baby is ready for complementary foods include:

• Being able to control head and neck
• Sitting up alone or with support
• Bringing objects to the mouth
• Trying to grasp small objects, such as toys or food
• Swallowing food rather than pushing it back out onto the chin.

3. How should I start giving my child fish?

Fish is a common food allergy. Introduce fish and shellfish while watching for signs of an allergy for several days before feeding your child fish a second time. If there is a history of food allergy in the family or your child develops any signs of food allergy, consult with your child’s doctor or nurse. There is no evidence that delaying introduction of allergenic foods, beyond when other foods are introduced, helps to prevent food allergy.

How much weight you should gain depends on your health and how much you weighed before pregnancy:

• If you were at a normal weight before pregnancy, you should gain about 25 to 35 pounds
• If you were underweight before pregnancy, you should gain more
• If you were overweight or had obesity before you became pregnant, you should gain less

Check with your provider to find out how much weight gain during pregnancy is healthy for you. You should gain the weight gradually during your pregnancy, with most of the weight gained in the last trimester.

Immune system changes in pregnant women place the women themselves, their unborn children, and their newborns at increased risk of foodborne illness. These illnesses can be worse during pregnancy and may lead to miscarriage or premature delivery. Some foodborne illnesses, such as Listeria and Toxoplasma gondii, can infect the fetus even if the mother does not feel sick. This is why doctors provide pregnant women with specific guidelines about foods that they should and should not eat.

Advice Regarding Seafood

Women who are pregnant or may become pregnant—as well as breastfeeding mothers and parents of young children – should make informed choices when it comes to seafood. Fish is one source of high quality protein, minerals, and vitamins that are beneficial to overall health. However, it is important to choose fish that are safe to eat and offer health benefits.

Cook seafood thoroughly: All seafood dishes should be cooked to 145°F. Raw seafood may contain parasites or bacteria, including Listeria, that can make pregnant women ill and could potentially harm their babies. This means that you should avoid:

• Sushi
• Sashimi
• Raw Oysters
• Raw Clams
• Raw Scallops
• Ceviche

Take care with smoked seafood: Refrigerated smoked seafood presents a very real threat of Listeria. Don’t eat refrigerated smoked seafood unless it’s in a cooked dish, such as a casserole, that reaches an internal temperature of 165°F to kill harmful germs.

Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, are often labeled as:

• Nova-style
• Lox
• Kippered
• Smoked
• Jerky

It is OK to eat smoked seafood during pregnancy if it is canned, shelf stable or an ingredient in a casserole or other cooked dish.

Don’t Drink Unpasteurized Juice or Cider

Unpasteurized juice, even fresh-squeezed juice, and cider can cause foodborne illness. These beverages have been linked to outbreaks caused by E. coli and other harmful germs. To prevent infection, either choose a pasteurized version or bring unpasteurized juice or cider to a rolling boil and boil for at least 1 minute before drinking.

Avoid Raw Milk, Raw Milk Soft Cheeses, and Other Raw Milk Products

Raw milk is milk from any animal that has not been pasteurized to kill harmful bacteria. Raw milk, also called unpasteurized milk, may contain bacteria such as Campylobacter, E. coli, Listeria, Salmonella or the bacteria that causes tuberculosis. To avoid getting these foodborne illnesses, only consume pasteurized milk and milk products, including cheese.

Don’t eat the soft cheeses listed below unless they’re made with pasteurized milk. Make sure the label says “made with pasteurized milk.”

• Brie
• Feta
• Camembert
• Roquefort
• Queso blanco
• Queso fresco

Cheese made with unpasteurized milk may contain E. coli or Listeria. Instead of eating soft cheese, eat hard cheese such as Cheddar or Swiss.

Pregnant woman should pay particular attention at farmers’ markets to make sure that fresh and soft cheeses are pasteurized.

Cook Eggs Thoroughly

Undercooked eggs may contain Salmonella. Cook eggs until the yolks and whites are firm to kill germs. If you are making a casserole or other dish containing eggs, make sure the dish is cooked to a temperature of 160°F. Make sure that foods that contain raw or lightly cooked eggs are made only with pasteurized eggs. Do not eat foods that may contain raw eggs, such as:

• Homemade eggnog
• Raw batter
• Homemade Caesar salad dressing
• Tiramisu
• Eggs Benedict
• Homemade ice cream
• Freshly made or homemade hollandaise sauce

Don’t Eat Premade Meat or Seafood Salad (Such as Deli Chicken or Tuna Salads)

Don’t buy or eat premade ham salad, chicken salad, or seafood salad which may contain Listeria. These items are commonly found in delis.

Do Not Eat Raw Sprouts

Raw or undercooked sprouts, such as alfalfa, clover, mung bean, and radish may contain E. coli or Salmonella. Cook sprouts thoroughly.

Avoid Undercooked Meat and Poultry

All meat and poultry should be thoroughly cooked before eating. A food thermometer should be used to ensure that the meat has reached the USDA-recommended safe minimum internal temperature.

Following the minimum recommend internal temperature is important because meat and poultry may contain E. coli, Salmonella, Campylobacter, or Toxoplasma gondii.

CDC recommends the following preventive measures to reduce the risk of contracting toxoplasmosis from eating meat:

• Cook meat to the USDA-recommended minimum safe internal temperature.
• Freeze meat for several days at sub-zero (0 °F) temperatures before cooking to greatly reduce chance of infection.
• Wash cutting boards, dishes, counters and utensils with hot, soapy water after contact with raw meat, poultry, seafood, or unwashed fruits or vegetables.
• Wash hands with soap and water.

Reheat Hot Dogs and Luncheon Meats

Reheat these meats to steaming hot or 165°F before eating, even though the label says precooked. These meat items may contain Listeria and are unsafe to eat if they have not been thoroughly reheated.

• Hot dogs
• Luncheon (deli) meats
• Cold cuts
• Fermented or dry sausage
• Any other deli-style meat and poultry

Be Selective with Meat Spreads or Pâté

Do not eat refrigerated pâtés or meat spreads from a deli or meat counter, or from the refrigerated section of a store. They can contain Listeria. Meat spreads and pâté that do not need refrigeration before opening, such as products in cans, jars, or sealed pouches, are a safer choice. Refrigerate these foods after opening.

Don’t Eat Raw Dough

Unbaked (raw) dough or batter can make you sick. Flour hasn’t been treated to kill germs like E. coli. Raw eggs can contain Salmonella. Make sure batter is thoroughly baked or cooked before eating.