September 15, 2004

Why Is Sushi Banned During Pregnancy?

Sushi and alcohol are just the tip of the iceberg. In the last two decades, the lists of things a pregnant woman can't eat or do without putting the fetus "at risk" is a mile long. Not that I didn't mind eating sushi for two, but I had to wonder, what were all the pregnant women in Japan eating every day, if not fish?

Anyway, two articles that provide some slightly overwrought context to the dire warnings, paranoia and guilt ("If I eat that bleu cheese, my orange-sized fetus won't get into Harvard!"). On Slate, Sara Dickerson lays out a history of pregnancy diet advice. Turns out much of The Must Avoid list hysteria is timed to the introduction of the What to Expect When You're Expecting book series, in the early Eighties.

Meanwhile, Alex Kuczynski gives voice to the mothers on the Upper East Side charity benefit circuit, who, in a fit of Urbanbaby-fed masochism, added tanning, botox, brazilian waxes and manicures to the forbidden list. [Sample UB message board quote: "'You mean like a tanning bed? You can't be serious? It gets HOT in there. You're better off standing in a microwave!'"]

Question: what do sushi, obsessive pseudo-scientific diets, tanning salons, botox, a surge of parenting books in the Eighties, and hyper-programmed urban mothers have in common? Baby Boomers. I can't help wondering if there's a generational component to what seems like an increasingly anxiety-ridden, risk aversion-centered approach to pregnancy. Just thinkin.

Food Fright [Slate]
The Nine Months of Living Anxiously [NYT]


My guess, regarding sushi, and the fact that it's not verboten in Japan is that atlantic salmon are subject to parasitization and a number of bacterial and viral infections ( at least one of which can have an effect on humans (although I can't remember which one). Cooking/curing the salmon kills the parasites, and that's why it's safer not to eat atlantic salmon raw.

As far as I am aware, this is a (rare) problem for people who aren't pregnant too, so it's probably just a case of paranoia.

I recently read an article in a parenting magazine titled "Is Your Formula Safe?" The article discussed the rare bacterial risks associated with powdered formula (as opposed to liquid). They advocated using boiling water to make bottles. I'm pretty sure the risk of putting boiling water in a baby's bottle far outweighs the risk of bacterial infection from powder.

Ditto Toby. My doctor explained that the risk with raw-fish/unpasteurized cheese/lunch meat was that there is a slight risk of getting sick, but because you are preggo, that sickness can't be treated as easily, and can result in a miscarraige. So while it may seem a bit hyper-reactive, I didn't mind missing out on certain foods in order to increase the chances of having a healthy, full-term baby.

Amy's right. It's just the "unnecessary" increase in risk of infection.

I'm not a doctor, but I play one on the Internet.

I think it's just where Free Floating Anxiety happened to land this week. Women in France and Japan have perfectly healthy babies, every day. Who ever got sick from cheese, really?

I fully intend on eating sushi and cheese and eggs and drinking a daily cup of coffee. I hate peanut butter, but I just might try it. If you'se can't handle da cheese, mebbe you'se ain't my kid...

My (American) friend who lives in Japan went out for sushi every week during her pregnancy and didn't even think twice about it. She also didn't think twice about feeding her 2-year-old sushi at those same dinners, either. It's all cultural, IMO.

It's the same with peanuts - they advise against eating them, but I doubt that the Indonesian or West African cultures, both heavy on peanuts in cooking, would have survived for so long without someone noticing the kids were all collapsing from peanut allergies!

When it comes to certain foods we all know the overly litigious nature of some people. I mean there are certain cheeses that are banned from import to the US for example.

When it comes to sushi I suspect that it is a catch all recommendation as some people have a tendency to equate the "sushi" from the deli with the one you get at Bar Masa or Sushi Yasuda.
On the other hand I suspect the respect the nipponese sushi chefs have for their craft is not as present in most restaurants not in Nippon.
And we all "know" the japanese are hysterically more clean that us dirty westerners so...

Not sure if anyone will see this reply... I'm a little late to the game, but I just noticed this thread...

Actually, in Japan, doctors recommend against eating raw fish while pregnant... I'm sure plenty of women still do (hell, my wife's friend was still smoking and drinking for part of her pregnancy over there) but it's not advised, even in Japan. Remember, it's not like sushi is the only thing they eat there... actually, a lot of women don't like a lot of raw seafood in Japan. Sushi and sashimi are probably most popular among old men, from my experience (6-7 years) in the country.

I just came upon this site looking for information on sushi and pregnancy in Japan since I live in Tokyo. As a woman, I have to disagree with the last poster about the popularity of sushi and sashimi among women. At least in Tokyo, there are equal numbers of both sexes who eat and enjoy raw fish. Perhaps because fish is only sold super-fresh, many women prefer to prepare and eat sushi and sashimi at home, just as I do often for my family! I plan to ask my doctor about his recommendation on sushi and will update you all if it is different than in the US. Thanks for the wonderful discussion!

Neither the CDC nor the FDA have any warnings to women about eating sushi or sashimi during pregnancy. They do recommend you don't eat unpasturized cheese, hot dogs, luncheon meat, soft-serve ice cream and refrigerated smoked salmon or pate, due to the increased risk of listeria.

I have found the book "The Panic-Free Pregnancy: An OB-GYN Separates fact from fiction" by Dr. Broder to be very helpful in disseminating all the rumors and studies from one another to make the most logical choices without spending the entire 9 months hiding in the dark, terrified of solar radiation, among other things.

i'm with greg.daddy. I have no more to say.

I know that I am way late to this posting, but I recently became pregnant and instantly began looking to what I should and shouldn't eat. I've been frustrated, angered, scared and relieved all at once with half the things I read.

I did check the CDC's website to see what the annual infection rate of Listeria is (the infection which they like to scare the pregnant with). The number? 2500 in the US. Per year. Our population is 300,000,000+.

I ate sushi last night, albeit it was with cooked ingredients. I am not a fan of the raw fish. I just am very upset with the scare tactics of what pregnant women can and can't do. My mom scoffs at the things I tell her, and she constantly says, "All three of my kids turned out fine and I ate all that stuff".

[congrats, btw, and good not to get too overworked over hysterical warnings. But it's also good to keep in mind the actual risk factors pregnant women face: for example, of 300mm people, only 4 mm of them are pregnant each year. And of the 3000 listeria cases, a very high pct are pregnant women, so the specific risks are still small, but also much higher overall than you imply. Also, the situations where listeria infections occur are fairly specific, too: if you eat room temperature deli trays a lot, you're much more at risk. Figuring out what in your own life is an actual, potential risk, and what you might want to do to minimize it makes more sense for most people. -ed.]

Pregnancy lowers the immune system. Meaning that a pregnant woman is at increased risks for all illnesses. This is why women are told not to eat certain things and avoid crowds. If you're goal is a full term healthy baby, why put your growing fetus at risk for developmental delays. Just lay off the sushi for a few months. Pregos are 20 times more likely to become infected with listeria than a nonprego. Its the decreased immune system thing. Be careful ladies. There's no need to be paranoid, just cautious. Heat kills the dangerous microscopic bugs, so just eat sushi made with cooked fish for a change. No biggie.

[thanks for the comment, but I see several flaws in the logic you're putting forth, and i'd encourage the use of actual citations of data or recommendations rather than authoritative-sounding but ultimately personal advice. Listeria risk is small, but usually avoidable, and so it's worth watching out for. But focusing on sushi alone misses the risk posed from deli meat, unpasteurized foods, even some prepared foods like hot dogs (American Pregnancy Assoc on listeria risks). -ed.]

I just had sushi today, despite being pregnant. From a familiar restaurant, where I know the food to be 100% fresh.

Listeria is actually quite a character, as far as bacteria go. It's not your usual food-poisoning sorta germ at all. It is VERY BAD at competing with other bugs, and that's why you usually DON'T get listeria from the warm summer's day chicken salad, that you get your regular food poisoning from. Listeria is VERY SLOW at reproducing, and doesn't mind lacking warmth or oxygen. The infective dose of listeria (ie the number of bacteria you have to consume in order to get ill) is very big, but admittedly if old, immunodeficient OR PREGNANT, the infective dose can be lower.

All in all, fitting with the above info, listeria risk is greatest in products containing raw fish or unpasteurised milk that HAVE A VERY LONG SHELF LIFE (slow at reproducing) AND ARE REFRIDGERATED (tolerates the cold, poor at competing).

Vacuum-packed cold smoked salmon and cheeses made from unpasteurised milk are thus the actual risky foods that perhaps should be avoided, whereas fresh raw fish really isn't.

It is, of course, everyone's own call as to what lengths you want to go through to be sure you're doing everything you can etc. However, you can do all that, and things still go wrong. A mother just doesn't have control over everything.

What about all the good and natural omegas you get from fresh sushi? Better that, then buy it in a jar, packed in capsules full of stabilisers, gelatin and additives. Perhaps? There's so much crap around us that we can't completely avoid whatever we do (pollution, additives, radiation of all kinds etc etc) that I really don't think anyone should feel guilty about eating natural, balanced, healthy, additive-free food.

ps i AM a doctor (or will be in a month's time if i didn't mess up my exams ;)

I am 8 months pregnant and so far have eaten (in moderation) brie, camembert, smoked salmon, prawns (and other seafood like scallops) and peanuts and have lived to tell the tale. Not one single bout of sickness or stomach upset - although I do have a good constitution! I have not tried sashimi yet, but I am tempted to try it as I imagine at this late stage in the pregnancy, it is probably OK.

Doctors in the USA are so afraid of malpractice law suits that they have to tell you to stay away from practically everything. Any other Americans remember that salmonella outbreak from BAGGED SPINACH and LETTUCE a few months back? Chicken is ripe with salmonella (anatomically, chicken meat is paradise for the bacteria; it's usually killed through the cooking process but certainly not always).

My closing remarks: to the person who claimed that doctors in Japan recommend staying away from Sushi: that is just bold faced bullshit. He should do his own research on the internet. Lastly, Japan has one of the lowest infant mortality rates in the world--MUCH lower than the USA (i.e. more of their babies live after being born). This just would not be the case if Sushi were killing off tons of fetuses (fetusi?). Don't buy into the fear mongers of this nation.

@Chad - as someone who works in public health, I'm going to call you on two things. First, the spinach salmonella outbreak was real. While it's more commonly found on poultry products, salmonella can - and as we saw last year, does - contaminate vegetables, usually during processing.

Second - infant mortality and fetal mortality are largely unrelated things. Your attempt to connect the two - and sushi consumption, by proxy - makes absolutely no sense from a public health perspective.

That said, I've found nothing in the scientific literature that suggests that there's any significant danger in consuming well-prepared and properly handled raw fish while pregnant, other than the mercury issue (which is a fish issue, not a raw issue). All things in moderation!

What concerns me with eating sushi and seafood in general, is primarily mercury and PCB levels in fish. Cooking does not change the values of these harmful toxins and while there have been no specific studies on the effects of these substances on a fetus, there is a lot of information available about the effects on humans in general. When a human is forming, all systems are in danger of malformation and the risk is increased when you introduce these substances. Also, levels of mercury and PCB's have risen dramatically in the past few decades, so I don't think it is a cultural disrespect, but a fact of our modern world. Someone said something about peanuts and research has shown that peanut allergies have risen sharply in America (don't know about elsewhere) in the last 10 years.

I don't think it's appropriate to say "you shouldn't do this at all" but "if you do this, there is this risk" Risk is okay but it's also a personal decision, one that should be made by being able to read objective information and reason for oneself.

Mercury is a concern in swordfish, shark, and some shellfish. Tuna consumption is acceptable but should be limited and salmon is not a concern.

Don't forget, fish is a great source of protein and omega fatty acids for pregnant women!

"but I had to wonder, what were all the pregnant women in Japan eating every day, if not fish?"

LOL way to be ignorant. You really think Japanese people eat fish every single day or go out for sushi every single week?

People I know here eat sushi about as often as Americans do.

Interesting reading, but the ignorance is palpable. Sushi is rice! Cooked a certain way may be served with wrapped around or accompanied by various condiments. Sashimi is raw fish! If you're going to bother expressing an opinion on a subject at least ascertain what the subject might actually be called.

Actually, I just reviewed all the comments made over the years--and the original post--and I do not see any statements at all about sushi or sashimi that warrant such a snotty response. Sushi is not rice. Sushi is fish, sometimes cooked but mostly raw, and sometimes vegetables and pickles, served with rice [with vinegar, sugar, and mirin added]. There are at least three types: nigiri, on rice balls; maki [and temaki], rolls; and chirashi, which is sliced fish over bowl of rice. Fish by itself is sashimi.

The health question discussed here is the safety of eating raw seafood in some form during pregnancy. Using the term sushi in that discussion is entirely normal and correct, at least in the northern hemisphere. If all you have to contribute is impulsive and misguided condescension, then please move on.

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