How Safe is it to Eat Sushi or Raw Fish During in Pregnancy?

    Sushi in Pregnancy

    Eating sushi and raw fish is part of a healthy diet during pregnancy in Japan as long as you eat fish with safe mercury levels. There is no scientific evidence that eating sushi in pregnancy increases pregnancy complications. As long as you take certain precautions and eat low mercury fish then it should be safe to eat sushi in pregnancy.



    Everybody tells you to not eat sushi in pregnancy, but are they right? In Japan, sushi is considered healthy in pregnancy and there are many who believe that the American "pregnancy sushi ban" is insulting to Japanese culture.

    It speaks of ignorance and prejudice to reject a culture's most common foods based on unfounded health claims. In simple terms: There is no scientific evidence that sushi can do harm when eaten in pregnancy.

    According to PubMed and Motherisk: "...it is no longer necessary for pregnant women to avoid foods like ... sushi and sashimi. Regardless of whether seafood is raw or cooked, pregnant women should choose low mercury seafood (eg, salmon and shrimp) over higher mercury varieties (eg, fresh tuna). Pregnant women should ensure that their food is obtained from reputable establishments; stored, handled, and cooked properly; and consumed within a couple of days of purchasing."


    Food safety in general is a concern for the pregnant woman and the fetus, as they might be more susceptible to some food-borne illnesses with serious sequelae.

    The main three food-borne pathogens of concern for pregnant women include

    • Toxoplasma
    • Listeria monocytogenes
    • Salmonella enterica

    These organisms can be passed to the fetus and increase the risk for spontaneous abortion, stillbirth, or perinatal complications. Neither of these organisms are a concern when eating sushi.

    It is safe to eat raw fish (e.g. sushi and sashimi) in moderation, although women should choose low mercury fish, such as salmon and shrimp, over higher mercury varieties, such as fresh tuna.

    According to the dictionary, “Sushi is cold rice formed into various shapes and garnished with bits of raw fish or seafood.” Japanese food is generally considered low-fat and healthy, so one would think it it would be an ideal food for pregnant women. In Japan, pregnant women do not generally stop eating sushi when they become pregnant, and many Japanese pregnancy books suggest eating sushi as part of a healthy, low-fat diet during pregnancy. Japanese tradition has it that postpartum women get certain kinds of sushi in the hospital during their recovery.

    However, in the United States pregnant women are scared away from sushi by being told that raw fish can contain harmful bacteria and parasites. These warnings, however, often fail to mention specific bacteria and parasites that fish for sushi may contain, nor do they mention that fish prepared at sushi restaurants in the United States is usually flash frozen by the distributers before it gets to the restaurant; any parasites or bacteria in the fish is usually killed during the process.

    Mercury

    There are certain fish which pregnant women should not eat because of increased mercury levels (raw or cooked). Fish that pregnant women should not eat because of mercury levels include:

    • Swordfish
    • Mackerel
    • Shark
    • Tilefish

    Sushi in Pregnancy

    Tropical Fish Poisoning

    Tropical fish poisoning happens when a person eats fish (either cooked or raw) which contains certain toxins. The most common form of fish poisoning is Ciguatera poisoning which causes up to one million cases of fish poisoning a year. Ciguatera fish toxin is widely distributed throughout the Carribean and South Pacific. It is caused by eating fish raw or cooked which have ingested a microalga called Giambierdiscus toxicus. Persons poisoned with Ciguatera have nausea, vomiting, abdominal pain and other symptoms within 2-6 hours after eating the poisoned fish and there is no specific tretament. Other fish toxins include scombroid, tetrodotoxin, and saxitoxin which are among the rarest and most poisonest of them.
      
    Between the warnings about parasites in sushi as well as mercury and toxins in certain species of fish, pregnant women are being scared away from eating fish alltogether. This is potentially harmful since the fatty acids in fish are the ideal nourishment for a developing baby.

    More on fish and pregnancy HERE.

    So what does the evidence say about sushi and pregnancy?

    Over the last decade, doctors have been using "Evidence-based medicine (EBM)" to more uniformly apply the standards of evidence gained from the scientific method to certain aspects of medical practice. According to the Center for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

    There is no conclusive evidence in published literature that eating sushi in pregnancy has an adverse effect on the pregnancy or that pregnant women have more complications after eating sushi. There are few if any published reports on an adverse association between sushi and bad pregnancy outcomes.

    Before you go to an all-you-can-eat sushi bar, however, it's important to be informed about the benefits and risks of eating sushi and raw fish during pregnancy.

    Benefits and Risks of Fish During Pregnancy

    Fish is good for you, it's that simple. Not eating enough fish during pregnancy can have a negative effect on your baby's brain development.

    But what about all the warnings about fish? Can't it make you sick? The National Academy of Sciences Institute of Medicine concluded in a 1991 report on illness from eating seafood: "Most seafood-associated illness is reported from consumers of raw bivalve mollusks...The majority of incidents are due to consumption of shellfish from fecally polluted water."

    If you take raw and partly cooked shellfish out of the equation, the risk of falling ill from eating seafood is 1 in 2 million servings, according to a government calculation from some years ago. By comparison, the risk from eating chicken is 1 in 25,000. Over all, 76 million cases of food poisoning are reported each year.

    The main risk of illness from non-mollusks isn't from eating them raw. Rather, as the Institute of Medicine reports, the problem is "cross-contamination of cooked by raw product," which is "usually associated with time/temperature abuse." In other words, no matter what you order in a restaurant, if it is not kept at a proper temperature and protected from contamination, you're at risk.

    Sushi is a typical Japanese food with over a thousand years of history and tradition. It actually began as a way of preserving fish. The raw, cleaned fish was pressed between rice and salt by a heavy stone for a few weeks. Then, a lighter cover was used and a few months later it was considered ready to eat. Not until the 18th century did a chef decide to serve sushi in its present form as fresh fish and forget about the fermentation process altogether.

    • Nigiri sushi is the traditional sushi which is a slice of fish (occasionally cooked) or shellfish pressed by hand onto a pad of cooked rice. Fish roe is also served as nigiri sushi in a style called gunkan, meaning "boat." Nigiri sushi contains a hint of horseradish and is meant to be dipped in soy sauce. They are always served in pairs.
    • Maki sushi contains fish or other ingredients that are placed on rice and rolled with dried seeweed as an outer layer.
    • Sashimi is thin or thick slices of raw fish that are not served on top of individual rice rolls, but separately.
    • Temaki annd Chirashi sushi are assorted raw fish and vegetables over rice
    • Chakin Sushi is vinegared rice wrapped in a thin egg crepe hand-rolled cones made from dried seaweed
    • Inari Sushi is vinegared rice and vegetables wrapped in a bag of fried tofu
    • Oshi Sushi is Osaka-style sushi: squares of pressed rice topped with vinegared/cooked fish
    • Oshinko are Japanese pickles
    • Wasabi is Japanese horseradish (it's SPICY, watch out!

    In the fishing and food industries, precautions are taken in the prevention of infected fish from getting into our food supply, but that is not a 100% guarantee. Food-borne illness is not limited to sushi or seafood, but is a common concern of all food industries.

    Between 1973 and 1987, shellfish accounted for 2.8% of the cases of food-borne illness reported to the Centers for Disease Control (CDC). These statistics may seem high at first glance, but they are somewhat misleading. For example, one in three cases of seafood-borne illness in the U.S. between 1977 and 1981 were attributed to ciguatera, a toxin found only in tropical and subtropical fish, and another 37% of the cases during the same time period were attributed to scombroid poisoning, a toxin produced in the flesh of some species of fish when improperly stored at high temperatures. Therefore, the statistics reported by the CDC are skewed by illnesses which either affect only a small geographical area, or only occur with mishandling of fish.

    Uncooked meat or fish can potentially contain elements of worms or eggs, and the only way to fully kill worm eggs and other microorganisms is by fully and properly cooking fish and meats. Freezing fish will only kill mature parasitic worms. Illnesses that may develop from eating uncooked or undercooked fish or meats include hepatitis A, worms, parasites, viral intestinal disorders, and other diseases. In Japan there were a few reported cases of anisakidosis, a  tiny worms in sushi that can cause gastrointestinal complications, but cases of anisakidosis are not commonly reported in the U.S. Pregnant or not, you should know that any time someone eats raw, uncooked, or improperly or inadequately cooked/handled seafood, there may be a problem.

    Some have suggested that pregnant women should avoid any and all raw or undercooked meat, poultry, eggs and seafood (like sushi), as well as unpasteurized juice and milk, and soft cheeses, such as brie, feta and Camembert because these foods may contain bacteria that could be hazardous to you and your baby. But presently there are few cases of problems that justify generalizations.

    If you want to be sure you won’t have a problem from raw fish, eat only well-cooked fish. You don’t have to completely give up on sushi and the safest way to enjoy sushi is to choose the fully cooked or vegetarian varieties, such as those that include cooked seafood. Here are some types of sushi that contain cooked or marinated fish or no fish at all:

    • Ebi: Cooked jumbo shrimp. Anago is salt water eel that is precooked and then grilled before serving.
    • Unagi: Fully cooked freshwater eel that is grilled and then brushed with a teriyaki-like sauce.
    • Kani: Real crab meat and is always served cooked, but is sometimes cooked then frozen.
    • Saba: Mackerel that is always served after being salted and marinated for a few days, so in a sense, it is cooked.
    • California roll: Contains avocado and other vegetarian ingredients.
    • Kappa maki: Contains cucumbers.  

    Rest assured that overall, very few people in the United States get sick from eating sushi, and most infections occur from fish eaten at home, not from restaurants. You're much more likely to buy contaminated fish at your local supermarket than get it at a good Japanese restaurant.

    Still want to get another opinion? Read this New York Times article HERE.