Can You Eat Sushi When Pregnant? I Asked an Expert

Growing a human is grueling work, from the morning sickness and food aversions to the back pain and heart burn. Add to that a whole list of foods that are off-limits? Ugh. When I was pregnant, I wasn’t all that broken up about lunch meat or runny eggs…but you bet your butt the first thing I asked my OB was, “Can I have sushi?” (It’s one of my favorite foods, not to mention one of the few healthy things that sounded good while I otherwise survived on French fries, watermelon and ice pops.)

So, can you eat sushi when pregnant? I asked an expert to set the record straight.

• Dr. Sara Gottfried, M.D. is a women’s health expert who specializes in integrative medicine and the medical advisor to ŌURA.
• Emily Oster, PhD is an economist, founder of ParentData and author of Expecting Better.

Oh how I wish the answer was cut and dry (and that it was a resounding yes). Here’s what Dr. Sara Gottfried told me when I asked:

“Yes, just choose a safe and reputable source, make sure it smells fresh and avoid sushi with raw fish or seafood.”

Wait. I thought you just said yes…as in yes, I can have sushi?

Not quite. The American College of Obstetricians and Gynecologists (ACOG) says that you should avoid all raw or undercooked fish while pregnant, because “raw fish, including sushi and sashimi, are more likely to contain parasites or bacteria than fully cooked fish.” So when Dr. Gottfried told me you can have sushi while pregnant, she was only referring to sushi that contains cooked fish (California rolls, for example).

Here’s where I think it gets tricky. The reality is, no medical doctor is going to go on record and tell swaths of pregnant people that they can go to town at the raw bar, because they don’t want to be liable if someone does get sick. (And for the record, I’m not saying you should go to town at the raw bar either. More on that later.)

But some experts will tell you that eating sushi—including raw types—is fine for pregnant people, as long as it comes from a reputable source (i.e., not a gas station). Personally, my own obstetrician told me I could eat raw sushi a few times a week and that she herself (pregnant at the time) couldn’t live without a poke bowl. Did I eat sushi? Yeah, I did—I just avoided sushi made with high-mercury fish, like tuna.

This is how economist Emily Oster explains it in her pregnancy book, Expecting Better. Raw fish is considered off-limits due to the possibility of bacteria (she specifically notes salmonella and campylobacter), which cause foodborne illness. But, she explains, those bacteria present the same amount of risk to non-pregnant people and are unlikely to harm a fetus if contracted (unlike another bacteria, listeria—most commonly found on raw produce, raw milk and unpasteurized cheeses, cold cuts and prepared foods that have been contaminated—which poses far greater risk to pregnant women, can cross the placental barrier and harm fetuses and should be avoided at all costs). Oster’s advice is to proceed with normal amounts of caution. “Don’t worry too much about sushi,” she writes. “[It] might carry bacteria, but these bacteria are no worse when you are pregnant than when you are not.”

Per Gottfried, “the risks [of eating sushi while pregnant] come from uncooked sushi and improper handling of raw fish or seafood. Even if the establishment is reputable, it’s best to avoid raw fish products due to the increased risk of food poisoning or listeria.” (FWIW, despite Oster’s advice, there have been past listeriosis outbreaks from prepared sushi, but the FDA doesn’t currently include it in its list of high risk foods).

As for other risks, like parasites, any raw fish that’s known to harbor parasites is usually flash-frozen before being sold for consumption as sushi in the U.S., per the FDA. This process kills potential parasites, but not bacteria.

All that said, your risk tolerance may be lower than someone else’s, so if you don’t feel comfortable eating some (or all) sushi while pregnant, then don’t. I think it’s a good idea to use your best judgment and consult with your own doctor first. For example, my colleague Alexia—who is currently pregnant—told me, “I just asked my OB about this and he has zero issues with eating sushi, raw fish and all. His advice was just to go to a nice place and to eat clean food.”

“The SMASH fish offer a healthy source of vital omegas and are low in mercury,” Gottfried tells me. “The SMASH fish are salmon (especially wild-caught Alaskan), mackerel, anchovies, sardines and herring.” Other low-mercury fish and shellfish include shrimp, lobster, crab, oysters, scallops, trout, tilapia and cod, for starters. (You can find more information on mercury levels in fish through the Environmental Protection Agency, too.) And the FDA advises that pregnant and breastfeeding persons should consume about eight to 12 ounces of fish from its “best choices” list, or about four ounces from its “good choices” list (you can find both here).

Aside from raw fish, per Gottfried, “tuna and swordfish should be avoided to limit mercury exposure.” To go further, the FDA also advises that you avoid orange roughy, tilefish, shark, marlin and king mackerel, and also specifies bigeye tuna (some other tuna types, like skipjack, are low in mercury and fine to consume occasionally).

Regarding mercury: This was a sticking point for me during my pregnancy, and I spent an embarrassing amount of time anxiously Googling the mercury levels of fish on a Florida vacation. Again, my colleague Alexia shared her experience: “My OB said you’d have to eat the highest containing mercury fish every day for a year for it to be a problem.”

Can you eat sushi when pregnant? It depends on who you ask. Medical doctors agree that as long as the sushi is made with cooked fish or seafood, it’s safe to consume during pregnancy, but if you really want to eat raw sushi (like I did), you should talk with your own OB/GYN (they might say it’s fine).