On food cravings and prohibitions in pregnancy: I’ll take my steak rare, please

It is widely published and accepted that certain foods and substances are a total “no-no” for pregnant women. There are a gazillion websites that will happily list the things you can’t have if you’re pregnant: raw and undercooked meats (so, no sushi, and no rare steak); deli meats and hot dogs, (unless you heat them to steaming, yuck);  raw eggs (so no cookie dough, and no licking the pan when you make brownies); soft cheeses like brie, camembert, feta; fish high in mercury, such as swordfish, shark, or tuna more than once a week; caffeine at all for the first trimester, and over 200 mg daily thereafter; alcohol at all.

The prohibitions are generally based in facts. A woman’s immune system is naturally suppressed in pregnancy, so that she is less likely to reject the growing fetus. The suppressed immune system can’t fight off infections as well, and hence, she is more susceptible to all kinds of illness.

The prohibitions on raw and undercooked foods are meant to protect the vulnerable pregnant population from possible infection with Listeria monocytogenes, a deadly bug that can not only cause the pregnant woman to become quite sick and die, but is also highly associated with miscarriage and stillbirths. It has a 25% mortality rate among all infected individuals- VERY scary(1). Though Listeria is rare, on the order of about 150 cases per year in the entire U.S., it is absolutely something to want to avoid.

In a recent presentation by the USDA which reviewed a decade of data on reported Listeria outbreaks(2), almost all were associated with processed ready-to-eat meats, most commonly turkey deli meat and hot dogs. The rest were associated with soft cheeses made from raw milk, as in unpasteurized milk (one large outbreak was from a soft Mexican-style cheese, Queso Fresco), and also hogshead cheese (a jellied meat product made from pig parts, popular in Lousiana), and prepackaged chicken and tuna salads. There were other small outbreaks associated with alfalfa sprouts, and hummous.

My problem with this is, I crave rare meat when I’m pregnant. I can’t eat a well-done steak anyways, but when I’m pregnant, apparently some vampire gene awakens and I want bloody meat all the time. I know, I know. Gross. But there it is. So, can I order my steak rare? Based on the evidence, yes. Rare steak in the U.S. is not a reported source of Listeria, or very much else, for that matter.

I would also feel fine ordering a roast beef sandwich from a quality deli, where meats are whole and sliced right there in front of you. Deli meat that has been ground up and processed in some factory somewhere, like cheap turkey meat or bologna? No way, Jose.

Sushi- I love it. I know a pregnant physician who has happily eaten sushi throughout her entire pregnancy with no issue. I am considering following her example, as I can think of no reason not to, other than the usual fear of someone not washing their hands and then preparing your Rainbow Roll. But that fear is there for any food you order, from anywhere- be it salad, fruit, sandwich, or smoothie. So why make sushi off-limits?

And I will eat soft cheese made from pasteurized milk. Most cheese will say on the package if it’s made from pasteurized milk. If it doesn’t, we don’t buy it.

The raw and undercooked eggs prohibition is meant to help us avoid salmonella, a bug that generally causes a nasty gastrointestinal illness, but can rarely cause a more serious and even fatal infection, especially in pregnant women. Per the CDC, salmonella outbreaks have been associated with produce such as alfalfa sprouts and melons, raw chicken, peanut butter, and eggs ⁽³⁾. The eggs involved in outbreaks have been from large commercial farms, where chicken crowding contributes to the bug being passed around. In my medical training, I have also seen several cases associated with turtles and snakes from pet stores.

Now, I don’t want salmonella, but if I make cookies or brownies, I am licking that bowl. So we get fancy expensive free-range eggs from happy chickens. I will spend the extra dough, to eat some dough. Alfalfa sprouts- not generally something I crave or buy. We don’t have peanut butter in the house, as hubby is allergic to peanuts. And who is going to handle turtles and snakes in general?

The fish thing- potential Mercury toxicity. Easy. Who eats swordfish and shark and tuna from cans every week anyways?

Caffeine, ah, my caffeine. I drink coffee every morning. I purposefully cut down when pregnant to a smaller mug, but I drink my coffee. If I’d had a miscarriage, I probably wouldn’t drink coffee at all right now. But so far, so good.

Alcohol, oh, my wine. I love a glass of wine with dinner. But I gave it up for the entire last pregnancy with no problem, and have for this one, so far, also. I know that in Europe, women drink wine throughout their pregnancies, and there is no solid evidence that a glass a day can harm your developing baby. Cases of fetal alcohol syndrome are associated with great quantities of alcohol ingested by alcoholic mothers- I remember one case where the mother drank a full bottle of cheap vodka daily for her entire pregnancy. However, we don’t really know what amount of alcohol is really safe. And, it looks REALLY BAD for a pregnant woman to be seen drinking. To me, it’s easy to give up.

So, in short, we have no real evidence to mandate that pregnant women avoid rare steak and sushi, soft cheeses made from pasteurized milk, nor eggs from small free-range farms. On the other hand, processed deli meats and hot dogs, cheese made from raw milk, alfalfa sprouts, undercooked and raw eggs from large commercial farms, and frequent consumption of some fish, seem to be very clear no-nos. Caffeine and alcohol in moderation I believe are personal preferences based on your own experience. I’ll take my coffee every morning, no worries.

Meantime, I have to go, I have to change the kitty litter.

1.  http://www.cdc.gov/nczved/divisions/dfbmd/diseases/listeriosis/

2. www.fsis.usda.gov/PPT/Lm_Angulo_062309.ppt

3.  http://www.cdc.gov/salmonella/outbreaks.html