Foods to Avoid in Pregnancy: A Complete Guide

By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham

Pregnancy is a time when dietary choices matter more than at almost any other stage of life — both for what they provide and for what they might inadvertently expose the developing baby to. The list of foods to avoid in pregnancy can seem overwhelming at first, but understanding the reasons behind each restriction makes the decisions much clearer and easier to follow.

The restrictions fall into several categories: foods that carry risk of specific infections (listeriosis, toxoplasmosis, salmonella), foods with high levels of potentially harmful compounds (mercury, retinol, caffeine, alcohol), and foods that may have hormonal or pharmacological effects on the pregnancy. As my book My Pregnancy Guide notes, many of these restrictions are about risk reduction rather than certainty of harm — the risk from any individual exposure is often low, but the potential consequences when harm does occur can be serious.

On this page

1. Alcohol
2. Fish: which to avoid and which to eat
3. Raw and undercooked meat
4. Liver and vitamin A
5. Soft and unpasteurised dairy
6. Raw and undercooked eggs
7. Raw shellfish
8. Sushi and raw fish
9. Pâté
10. Soya products
11. Caffeine
12. Game meat
13. TCM perspective: foods to avoid
14. My Pregnancy Guide
15. References

1. Alcohol

There is no known safe level of alcohol consumption in pregnancy. The NHS recommends complete abstinence from alcohol throughout pregnancy. Alcohol crosses the placenta freely, and the developing brain and organs are vulnerable to its toxic effects throughout the entire pregnancy — not only in the first trimester.

Fetal alcohol spectrum disorders (FASD) represent the spectrum of permanent intellectual, behavioural, and physical abnormalities that can result from prenatal alcohol exposure. They are the leading preventable cause of intellectual disability in the developed world. The amount of alcohol required to cause harm varies between individuals and gestations — which is why there is no "safe" threshold that can be advised. The simplest and safest approach is to avoid alcohol entirely from the moment of confirmed (or even suspected) pregnancy.

2. Fish: which to avoid and which to eat

Fish is an extremely important food in pregnancy — it provides omega-3 fatty acids (DHA) essential for fetal brain and retinal development, high-quality protein, iodine, selenium, and vitamin D. The restriction applies only to high-mercury fish, not to fish as a food group.

Fish to avoid completely in pregnancy:

• Shark
• Swordfish
• Marlin
• King mackerel (not regular mackerel)
• Tilefish
• Bigeye tuna (raw)

These large predatory fish accumulate mercury (methylmercury) through the food chain. Methylmercury is a neurotoxin that crosses the placenta and concentrates in fetal brain tissue, impairing neurological development. The effects are proportional to level of exposure.

Tuna: Limit canned tuna to two tins per week (light tuna lower in mercury than albacore/white tuna); limit fresh/cooked tuna to two portions per week.

Fish to eat regularly: Salmon, mackerel (regular Atlantic or Pacific, not king), sardines, herring, anchovies, trout, and cod are all safe to eat 2–3 times per week and provide excellent DHA, which is irreplaceable for fetal brain development. Aim for at least two portions of oily fish per week.

3. Raw and undercooked meat

Raw and undercooked meat carries risk of two primary infections in pregnancy:

Toxoplasmosis: A parasitic infection caused by Toxoplasma gondii, which can cause serious fetal harm including cerebral damage, chorioretinitis, and stillbirth when contracted for the first time in pregnancy. Cook all meat thoroughly to an internal temperature of at least 70°C until the juices run clear. Avoid cured meats (Parma ham, salami, prosciutto, chorizo) unless they have been cooked — curing does not reliably kill toxoplasma. Avoid rare steak and raw/pink burgers.

Listeria: Bacteria that can cause listeriosis — a serious infection with a 20–30% fatality rate in fetuses and newborns. Cold deli meats, hot dogs, and luncheon meats should be heated until steaming before eating.

Additional precautions: wash hands thoroughly after handling raw meat; use separate chopping boards for raw meat and ready-to-eat food; do not eat meat-based stuffing from inside a whole cooked bird unless temperature has been confirmed throughout.

4. Liver and vitamin A

Liver is one of the richest food sources of retinol (preformed vitamin A). While vitamin A is essential in small amounts, high intake of retinol during pregnancy — particularly in the first trimester — is associated with fetal malformations affecting the head, face, heart, and nervous system. A single 100g portion of beef liver provides approximately 6500 mcg retinol — approximately 10 times the recommended daily intake for pregnant women (600 mcg).

The NHS recommends avoiding all liver and liver products (pâté, liver sausage, liver pâté) throughout pregnancy. This is a precautionary recommendation based on the highest-risk scenario; an occasional very small amount is unlikely to cause harm, but consistent avoidance is the safest approach.

Note: beta-carotene (the plant precursor to vitamin A, found in carrots, sweet potatoes, and leafy greens) is not associated with the same risk — the body regulates conversion of beta-carotene to retinol, and it is not possible to consume harmful quantities from plant sources.

Note also: liver is an excellent food for preconception preparation (see fertility diet guide) — the restriction applies during pregnancy, not before.

5. Soft and unpasteurised dairy

Certain cheeses carry listeria risk and should be avoided in pregnancy:

• Soft, mould-ripened cheeses: Brie, Camembert, Taleggio
• Blue-veined cheeses: Stilton, Roquefort, Gorgonzola, Danish Blue — whether soft or hard
• Soft goat and sheep's milk cheeses: Chèvre, Feta (unless pasteurised and used in cooked dishes)
• Unpasteurised (raw) milk, cream, butter, or cheese of any kind

All hard cheeses are safe regardless of pasteurisation (the low moisture content prevents listeria survival): Cheddar, Gruyère, Parmesan, Edam, Gouda, and similar hard cheeses are all fine. Soft processed cheeses (cream cheese, mozzarella from pasteurised milk, ricotta from pasteurised milk), cottage cheese, and soft goat or sheep's cheese are safe if made from pasteurised milk.

Soft cheeses and blue cheeses that are cooked until they are piping hot throughout (e.g. baked brie in pastry, blue cheese sauce served hot) are generally considered safe, as listeria is killed by thorough heating.

6. Raw and undercooked eggs

Raw and lightly cooked eggs carry a risk of salmonella infection, which can cause severe gastroenteritis in pregnancy and, in serious cases, preterm labour. In the UK, eggs bearing the British Lion mark (stamped on the shell) are produced under a scheme that vaccinates hens against salmonella and are considered safe to eat with runny yolks in pregnancy. Eggs without the Lion mark should be cooked until both white and yolk are solid.

Foods made with raw eggs to avoid include: homemade mayonnaise, homemade hollandaise sauce, homemade caesar dressing, homemade ice cream with raw egg, homemade mousse, and uncooked egg-based desserts. Commercially produced versions of these foods typically use pasteurised egg and are safe.

7. Raw shellfish

Raw shellfish — particularly oysters, clams, mussels, and other bivalves — filter large volumes of sea water and can concentrate bacteria, viruses, and naturally occurring biotoxins. The primary risks are norovirus, hepatitis A, and vibrio infections, all of which can be more severe in pregnancy. Shellfish should always be cooked thoroughly in pregnancy — steaming until the shells open, with any that do not open discarded. Cooked prawns, cooked scallops, and cooked crab are all safe.

8. Sushi and raw fish

Raw fish carries risk of anisakis (a parasitic worm), listeria, and various bacteria. Commercial sushi-grade fish in reputable restaurants is typically frozen before use, which kills anisakis parasites — but the same cannot be said of all preparations. During pregnancy, cooked sushi (prawn, crab, vegetable, egg) is the safest option. Raw fish sushi and sashimi are best avoided, particularly from sources where the freezing provenance is uncertain.

9. Pâté

All pâté — including vegetable pâté — carries a higher listeria risk than other ready-to-eat foods because of the way it is produced and stored. The NHS recommends avoiding all pâté in pregnancy, whether meat, fish, or vegetable-based. This includes Ardennes pâté, chicken liver pâté, fish pâté, and smooth vegetable spreads sold as pâté.

10. Soya products

As noted in My Pregnancy Guide, soya is best avoided during pregnancy. Soya contains phytoestrogens (isoflavones) — plant compounds that can mimic oestrogen in the body. High soya intake during pregnancy may theoretically affect fetal endocrine development, particularly in male fetuses whose reproductive development is sensitive to oestrogen-like compounds during specific developmental windows. While occasional consumption of traditional fermented soya (miso soup, a small portion of tofu) is unlikely to cause harm, regular consumption of soya milk, soya-based dairy alternatives, soya protein powder, and soya meat substitutes is best reduced or avoided.

11. Caffeine

The NHS recommends limiting caffeine to no more than 200mg per day during pregnancy. Higher intakes are associated with increased risk of miscarriage and low birth weight. Caffeine crosses the placenta freely, and the fetus has limited capacity to metabolise it.

Approximate caffeine content:

• Mug of instant coffee: 100mg
• Mug of filter coffee: 140mg
• Mug of tea: 75mg
• Can of cola: 40mg
• Can of energy drink: 80mg (plus other potentially harmful ingredients — energy drinks should be avoided entirely)
• Bar of dark chocolate (50g): 25mg

One or two cups of tea or one cup of coffee per day is within the recommended limit. Herbal teas should be chosen carefully — peppermint, ginger, and chamomile in moderation are generally considered safe; high-dose raspberry leaf is recommended from 32 weeks onwards; some herbal teas (liquorice root in high doses, sage, pennyroyal) should be avoided.

12. Game meat

Wild game meat (venison, pheasant, partridge, grouse, rabbit, hare) may contain lead shot fragments from the ammunition used to kill the animal. Lead is a neurotoxin with no safe level of exposure for the developing fetus. The NHS advises that pregnant women should avoid eating game meat that may have been shot with lead shot.

Farm-raised game (venison from deer farms, game birds from shooting estates where only steel shot is used) is not subject to the same concern. Check provenance where possible.

13. TCM perspective: foods to avoid

Traditional Chinese medicine adds a layer of constitutional and energetic caution to the list of foods to avoid in pregnancy. Beyond the Western food safety concerns, TCM advises:

• Extremely cold and raw foods: Ice-cold drinks, ice cream, large amounts of raw salad, cold smoothies — all deplete Kidney Yang and impair the Spleen's transformation function, reducing the quality of nourishment available to the developing baby
• Extremely spicy foods: Excess chilli, pepper, and pungent spices can generate internal heat and disturb the fetus in TCM terms; may also worsen heartburn
• Crabs: In classical TCM texts, crabs are considered cold in nature and are thought to loosen the muscles — traditionally advised against in large amounts during pregnancy
• Alcohol (warming but toxic): Confirmed unsafe by modern evidence, consistent with classical TCM prohibition
• Excess bitter and cool foods: Some bitter and cooling foods (green tea in large amounts, strong bitter greens) are cautioned against in early pregnancy in TCM texts, reflecting the classical concept of protecting the warmth and stability of the early pregnancy environment

These TCM food cautions add nuance to the dietary approach but should be viewed alongside — not in opposition to — the evidence-based guidance above.

14. My Pregnancy Guide

15. References

• NHS. Foods to avoid in pregnancy. 2023. Available at: www.nhs.uk/pregnancy/keeping-well/foods-to-avoid/
• Strom M, et al. Fish and long-chain n-3 polyunsaturated fatty acid intakes during pregnancy and risk of postpartum depression. Ann Nutr Metab. 2009;54(4):289–296.
• Myers GJ, Davidson PW. Prenatal methylmercury exposure and children: neurologic, developmental, and behavioral research. Environ Health Perspect. 1998;106(suppl 3):841–847.
• Oken E, et al. Associations of maternal fish intake during pregnancy and breastfeeding duration with attainment of developmental milestones in early childhood. Am J Clin Nutr. 2010;92(5):1072–1079.