Ah, Sushi. Healthy, delicious, fresh… but can pregnant women eat it? Is it safe? Why not? What happens if you accidentally eat it?
After so many questions about what kind of sushi is OK, whether it should be cooked, and a million other queries from hungry pregnant women (I hear you), I’ve put together this ultimate guide to sushi during pregnancy.
Can Pregnant Women Eat Sushi? The guidelines on sushi vary depending on which country you’re in. The consensus is that pregnant women should avoid raw fish and seafood due to the risks of bacteria or pathogens. However, there are many cooked sushi dishes that are pregnancy-safe.
I’ve included the whys and why nots, a safe sushi list, and much more.
Science-backed, medical and government sources were all used to produce this ultimate guide, so I hope you find it useful – no matter which country you’re in.
Sushi Advice By Country
In almost every country, pregnant women are advised to avoid eating raw fish sushi or sashimi, due to the risk of either harmful parasites or bacteria – sometimes from cross-contamination rather than the fish itself.
Across the board, raw shellfish should always be avoided, too.
- In the United States, the Department of Health recommends that pregnant women avoid raw fish sushi (source: FoodSafety.gov). The FDA also repeat this advice in their leaflets for pregnant women (source: FDA).
- In the UK, the National Health Service says that you can eat raw fish sushi, as long as it’s been frozen first, to kill any potential parasites (source: NHS). The advice that raw shellfish should be avoided is the same as in other countries.
- In Australia, the advice is not to eat any raw fish or seafood (source: NSW Food Authority).
Note: Please don’t let this put you off fish! Fish is an extremely nutritious and beneficial food during pregnancy (source: Epidemiology Journal). You should be eating fish – but choose cooked fish that isn’t high in mercury.
Do Pregnant Japanese Women Eat Sushi?
Time to address one of those pregnancy myths around sushi. I kept seeing anecdotal comments that “pregnant women eat sushi in Japan”. Well, do they?
I couldn’t find any evidence of this from any medical or government source.
In fact, the Japanese Ministry of Health published a leaflet for pregnant women stating that food should be heated to an internal temperature of at least 75C for one minute. That would automatically mean sushi isn’t a safe option (Source: Japanese Ministry of Health).
The ‘foods to avoid’ list includes smoked salmon and fish pate, too. If the Japanese say not to eat smoked salmon, it’s hard to imagine they’d say unsmoked salmon or other raw fish was OK.
Finally, I read some Japanese “Q and A” websites with answers from qualified doctors. An obstetrician and gynecologist advised Japanese women not to eat raw fish (1), and this was seconded by another Gynecologist (2).
The conclusion is that both doctors and the Health Ministry in Japan quote the same risks of eating raw fish, and advise against it.
Why Can’t Pregnant Women Eat Sushi? The Risks Explained
“Why can’t I eat sushi if I’m pregnant?”
I get this question a lot.
The truth is, pregnant women CAN eat sushi, but certain types are safer than others.
The word ‘sushi’ actually refers to the rice, rather than a filling or topping, so saying “sushi is unsafe” is a bit misleading. It’s just that some of the toppings and fillings are better and less risky than others when you’re pregnant.
Raw or undercooked seafood and fish carry a few risks for pregnant women. These are:
Listeria Monocytogenes and other Bacteria
Contrary to what many people think, raw fish does not automatically ‘contain’ listeria. Listeriosis is a rare but serious complication in pregnancy that can cause severe illness and miscarriage (source: PMC).
Contamination with listeria tends to happen during preparation, packaging, or storage. It thrives in cool temperatures, even in a fridge. Other bacteria are transferred in similar ways, from cross-contamination or other ways the food is handled.
In other words, contamination can happen at any stage in the food processing chain. It also occurs if the fish undergoes more processing steps, like curing and smoking (source: PubMed).
Heat above 65C / 150F kills bacteria and listeria (source: EFSA). However, because the fish is raw, there’s no opportunity to do so, and the bacteria remain on the fish. That’s why cooked fish is safe, and raw fish is best avoided.
Parasitic Infections (Anisakiasis)
Anisakiasis (also called anisakidosis) is a parasitic disease caused by eating raw seafood and fish that are contaminated with worms (nematodes). It’s a less than delightful thought, I know.
The British Medical Journal noted in 2017 that although most cases were in Japan, it was becoming more prevalent in Western diets. This was attributed to more people eating raw fish like sushi (source: BMJ).
A 2016 study looked at the potential dangers in pregnancy, and concluded that Anisakiasis can cause anemia and altered immunity in pregnant women, and carried the potential risk of preterm births or growth restriction for the fetus (source: PubMed).
The good news is that the parasitic worms that might be present in fish are killed in two ways:
- Cooking or heating the fish to an internal temperature of 145F / 63C (source: FDA)
- Freezing the fish for 7 days at -4F / -20C (source: FDA).
You can check this with proper food thermometers – my recommended ones are here.
Commercial manufacturers may ‘deep freeze’ the fish at an even lower temperature for a shorter time, but most domestic freezers only go to about -25C, so the 7-day option is the safest to achieve at home.
It’s worth mentioning that most commercially-made sushi uses deep-frozen fish. However, there’s still the risk of bacterial contamination, which is why many countries advise against eating raw fish when you’re pregnant.
High Mercury / Unknown Fish types
One of the other issues with sushi is that when it’s prepared, it’s hard to identify the exact fish species – especially if it’s tuna.
Yellowfin (ahi) is popular in sushi restaurants but should be eaten in moderation because of its mercury content. You can read my guide to tuna and mercury here.
It’s also very hard to tell if a fish (like salmon) is wild-caught or farmed (want a salmon guide? There’s one here).
Even if the fish is cooked, high mercury types should be avoided in sushi. These are listed under ‘risks’ above.
Can Pregnant Women Eat Cooked Sushi?
Almost all the risks detailed above are significantly reduced by only eating cooked sushi, which is the type recommended that pregnant women stick to.
You can still eat fish sushi, so long as the fish is cooked – for example, in a tuna roll that contains canned tuna, or tuna mayo. You still need to check the mercury in tuna – here’s a handy guide to help with that.
Fish with high mercury levels is best avoided – even if it’s cooked. In sushi, this means that you should avoid:
- King Mackerel
- Some types of tuna – there’s a complete guide to tuna here
- Northern Pike
Some of these are uncommon in sushi, anyway. The one you’ll come across the most are swordfish and tuna – so you’ll probably want to read my complete guide to tuna in pregnancy, too.
“Cooked” sushi can also include ones topped with grilled eel (read more about eel dishes in pregnancy here), cooked eggs like omelets, cooked shrimp and prawns, chicken, tempura, and all types of veggie sushi, too.
That means there’s plenty of safe, cooked sushi options for pregnant women to choose from. To help you out when ordering or making your own, a list of pregnancy-safe sushi is below.
Reading a Sushi Menu When You’re Pregnant
I’ve provided ‘safe’ and ‘avoid’ lists below, but first, you’ll need to know how sushi menus are written.
The ingredient is always named first, followed by the method of preparation. There’s an illustration of all the different types in an image below. For example, “Anago Nigiri” is a slice of eel on a piece of rice.
Nigiri = sliced meat or fish laid over pressed rice
Maki = rolled with rice inside seaweed
Uramaki = rolled with rice on the outside
Sashimi = Sliced raw fish
Temaki = sushi hand roll, rice and filling in a seaweed cone
Gunkan = Small amount of rice wrapped in seaweed with an open topping
Safe Sushi in Pregnancy List: The Kinds You Can Eat
Here’s a list of safe sushi rolls (and other types) that I’ve put together as a reference. This list names the main ingredient. It’s usually followed by another word describing the preparation (illustrated above).
I’ve given both the Japanese name and the description. In all cases, try to get it as fresh as possible!
Many restaurants offer veggie combos, bespoke rolls, or “no raw fish” options, so ask when ordering.
|Eel (always cooked)
|Monkfish liver, usually cooked. Eat in moderation (see guide here)
|Usually cucumber, imitation crab and avocado, which are all safe.
|Uses cooked chicken instead of fish
|Japanese radish; either fresh or pickled is fine
|Usually shrimp tempura, avocado, cucumber and spicy sauce, which are all OK
|Fried Tofu – eat in small amounts as soy should be eaten in moderation
|Imitation Crab (surimi) which is always cooked
|Usually made with a cooked soft shell crab, check other ingredients
|Tomago / Tamagoyaki
|Fried egg or omelette
|Made with cooked fried ingredients
|Often refers to canned, cooked tuna – check first
|Pickled Ume Fruit
|Freshwater Eel (always cooked)
|Veggie or Vegetarian
|Will only contain vegetables so a good choice
List of Sushi to Avoid in Pregnancy
In case you’re in a restaurant or just need a quick answer to which specific rolls or options to avoid, here are the most common ones that feature raw seafood or fish.
There are so many types of sushi, it’s not an exhaustive list. If you’re not sure, ask before ordering whether it’s raw fish or seafood.
This list names the main ingredient. It’s usually followed by another word describing the preparation (illustrated above).
|Jack Mackerel (usually raw)
|Bluefin Tuna Loin (usually raw)
|Check this one as it can contain many different things
|Yellowtail (usually raw)
|Scallop (usually raw)
|Squid (often raw)
|Skipjack Tuna (usually raw)
|Lean Tuna (usually raw)
|Fillings vary, so check first
|Not the drink! Usually refers to raw salmon
|Raw sliced fish or seafood
|Spicy Tuna Roll
|Usually made with raw tuna
|Sea Bream (usually raw)
|Fatty Tuna belly (usually raw)
Is Sushi Rice OK If I’m Pregnant?
Sushi rice is usually safe during pregnancy. It’s not mixed with anything other than a little rice vinegar, sugar and salt.
Sushi rice should be eaten as soon as possible after it’s freshly made. If you’re making it yourself, or have bought takeout that you’re not going to eat, wrap it securely in the fridge and eat it within a couple of days.
Always make sure that freshly cooked sushi rice has cooled before putting it in the fridge, or you’ll increase the temperature of your fridge beyond what’s safe. A good fridge thermometer helps with this.
What about Sushi Sides Like Wasabi, Pickled Ginger or Soy Sauce?
In restaurants and sushi joints, sushi is often served with a wasabi paste. This is often not ‘real’ wasabi (Japanese horseradish) as it’s expensive and hard to source.
The wasabi paste you’re likely to get is made from various ingredients including horseradish, mustard and green coloring. This wasabi paste is safe in pregnancy.
In case you’d heard this common myth – no, spicy food like wasabi won’t harm your baby – you can read more about spicy food in pregnancy here.
Pickled ginger is also safe in pregnancy and may even help with nausea, too.
Finally, soy sauce is also safe, as are other common dipping sauces such as teriyaki, oyster sauce or eel sauce.
If you’re eating at a Japanese restaurant that serves more than just sushi, you might want to read this guide to eating out when you’re pregnant.
Can I Eat Caviar, Fish Eggs or Fish Roe On Sushi?
Fish eggs are frequently used as colorful decorations on many kinds of sushi. The Japanese terms for these include Masago (smelt roe), Tobiko (flying fish roe) and Ikura (salmon roe), as well as the usual black caviar types.
In short, these are only safe if both pasteurized AND held under refrigeration, even when unopened. Here’s my article on caviar, fish eggs and fish roe safety in pregnancy if you want to learn more.
Can I Eat Sushi in the First Trimester?
So long as it doesn’t contain raw fish or seafood, you can eat sushi safely in any trimester if it’s cooked, including in the first trimester, or early pregnancy.
Use the safe list above to guide you as there are some other things to look for, such as omelette-types being made only from fully cooked egg.
Can I Eat Homemade Sushi?
If you make sushi yourself (I’m impressed!), then you can safely stick to the ‘safe’ sushi toppings and fillings on the list given above.
Eat your sushi as soon as possible after it’s been prepared and follow good food hygiene practices. Sushi doesn’t last very long in the fridge, so try to eat it within a couple of days of preparing it.
You can also search the site for individual ingredients or toppings you usually use. Use the magnifying glass icon at the top right.
If you’re in the UK you could also use raw fish that has been frozen first. This is one of the few countries where the national guidance from the NHS says that you can eat raw fish sushi (source: NHS). It’s ultimately your choice whether you want to or not.
What About Sushi in a Restaurant, or a Takeout?
Most sushi places are hygienic because they have to be – in the UK you can check the Food Standards Agency scoring system. In the USA, some food inspection ratings are on Yelp, too.
Use your usual common sense when choosing a restaurant to eat at. If it has an open kitchen and you can see the sushi being prepared (which is quite common), you can eyeball the cleanliness for yourself.
If you see anything that looks unhygienic or sketchy, then skip the restaurant and choose somewhere else – just as you’d do if you weren’t pregnant!
Tip: Common chains like Yo! Sushi, Itsu and others should all be fine to eat at when you’re pregnant, if you stick to the ‘safe sushi list’ above.
There’s a guide here to eating at restaurants during pregnancy that you might find helpful.
I Ate Sushi and Now I’m Worried – What Happens?
If you’ve accidentally eaten uncooked fish sushi, then the first thing is not to panic. The odds of the sushi containing listeria or other bacteria are still very low.
Pregnant women are advised not to eat raw or undercooked fish and seafood in order to reduce an already low risk. The primary aim is to avoid foodborne illness during pregnancy, as this may cause complications.
Therefore, it’s best to adopt a ‘watch and wait’ approach, to see if you have any symptoms of foodborne illness. This is sometimes hard in pregnancy, especially if you’re already nauseous, as this may mirror food poisoning.
Listeria, for example, appears within 2-30 days of eating contaminated food, and can cause headaches, muscle aches, nausea, flu-type symptoms, vomiting or fever (source: American Pregnancy Association).
If you experience any of these symptoms or anything that is out of the ordinary for you – even if they’re mild – then contact your doctor or a health professional straight away, to be on the safe side.
Going forward, it’s better to stick to cooked or vegetarian sushi, or ones on the ‘safe’ list above to further reduce your risk.
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