Pregnancy comes with a long list of do's and don'ts—some more confusing than others. (Example A: See what the experts have to say about whether you really have to quit coffee while you're pregnant.) But one rule that's pretty well agreed upon by doctors? You can't eat sushi while pregnant—which is why Hilary Duff's recent Instagram post is causing so much controversy.
Earlier this week, a pregnant Hilary Duff posted a photo of her and a friend enjoying a spa day followed by a sushi dinner. Almost immediately, the comments exploded with concerns that Duff was eating raw fish, which medical experts advise pregnant women to avoid.
What's wrong with eating sushi while pregnant?
"Since sushi is made of raw fish, there is always the higher risk of parasites and bacteria," says Darria Long Gillespie, M.D., an ER doctor. "While those don't always cause a significant problem in adults, many of them can cause severe damage to the developing baby, which is why they're scary. If the sushi was stored properly, then the risk should be very low, but there's no benefit to eating sushi over cooked fish so, honestly, why risk it?"
If you do get sick from eating sushi while you're pregnant, it can be really risky, says Adeeti Gupta, M.D., a board-certified gynecologist and founder of Walk In GYN Care in New York—it's more serious than a run-of-the-mill case of food poisoning that you might get when you're not pregnant. "Although the gut infections from bacteria including E. coli and salmonella that sushi may carry are treatable, they can be severe and can cause dehydration and affect the pregnancy," explains Dr. Gupta. On top of that, these infections typically need to be treated with antibiotics, she adds, some of which aren't safe to use during pregnancy.
Raw fish can also transmit listeria, a bacterial infection that's more common in pregnant women and newborns, according to the Centers for Disease Control and Prevention. (See: 5 Things You Need to Know about Listeria.) During pregnancy (especially early-on), a listeria infection can be devastating. "It can cause miscarriage, fetal death and growth restriction," says Dr. Gupta.
What about other fish?
The concern over bacteria only applies to raw fish, according to the experts. "Anything that has been cooked at a temperature high enough to kill the bad bacteria is safe," says Dr. Gupta. "As long as the food has been cooked at an average above 160 to 170° Fahrenheit, it should be safe for consumption, provided it has not been handled by an infected person after cooking." In other words, you don't have to give up your favorite grilled salmon recipe for nine months—just your salmon avocado rolls.
That said, you should still limit your cooked fish consumption if you're pregnant, says Dr. Gillespie. "All fish, whether cooked or raw, contain the risk of mercury ingestion," she says. Exposure to mercury can harm the central nervous system—especially in the developing brain of a fetus, according to joint advice from the Food and Drug Administration and Environmental Protection Agency. Dr. Gillespie recommends limiting your cooked fish consumption to no more than one or two servings a week. And when you do nosh on cooked fish, opt for low-mercury varieties like salmon and tilapia. (For more recommendations, the FDA created a chart detailing the best and worst seafood to pick on the menu.)
The Final Word On Eating Sushi While Pregnant
Bottom line: Raw fish is a no-go (sorry, Hilary) if you're pregnant. To cut down your risk of picking up a harmful bacteria, "stay away from raw and uncooked meats or seafood, unpasteurized cheeses, and make sure you thoroughly wash any raw salads or vegetable before consuming them," says Dr. Gupta.
Technically, you can still have sushi that doesn't include raw fish, like veggie rolls or cooked tempura rolls. But personally, Dr. Gillespie feels even this can be risky. Even if you really want to go to your favorite sushi spot and just get a California roll, remember that the chefs probably use the same countertops and knives to cut all the sushi, whether it had raw fish or not. So to be extra cautious, consider saving sushi night as a post-pregnancy treat. (Consider making these homemade summer rolls to fill your sushi-like craving instead.)