Being pregnant means you’re about to swim in a sea of “do’s and don’ts.” Mostly don’ts. Co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D. discuss the many foods that society tells pregnant women to keep off their plates. What’s science? What’s fiction? What’s in between? Learn all about: * Safer ways to eat sushi * The big reach and risky business of listeria: Why soft cheeses, deli meat, packaged salads and, brace yourself, ice cream can be carriers * Why you should always wash raw fruit and veggies, and leave dealing with the cat’s litterbox to your partner
Dr. Angela Mattke:
Welcome to the Mayo Clinic Moms podcast. We're having candid conversations and answering difficult questions about pregnancy, raising kids, and everything Mom-related. I'm Dr. Angela Mattke, and I'm a mom of two and a pediatrician at Mayo Clinic Children's Center in Rochester, Minnesota. And my co-host is Dr. Nipunie Rajapakse, who's a pediatric infectious disease doctor also at Mayo Clinic and is also pregnant. Hi friends. I'm here again with my friend, Dr. Nipunie Rajapakse. And today on our episode, we're gonna be talking about all the do's and don'ts of pregnancy.
Dr. Nipunie Rajapakse:
There are a lot.
Dr. Angela Mattke:
There are a lot, and I feel like everything in pregnancy is a don't. There are very few things that are on the do list.
Dr. Nipunie Rajapakse:
I agree. It seems like there are so many restrictions and expectations to give up so many different things.
Dr. Angela Mattke:
Yes.
Dr. Nipunie Rajapakse:
So hopefully we can help shed some light on where some of these things come from.
Dr. Angela Mattke:
Especially the evidence behind these things, where they come from, and are some of them truly evidence-based or not? I guess that's the question we'll kind of get to a little bit here. So during my pregnancies, I was so sick, and I would run out of the patient room, need-to-vomit sick.
Dr. Nipunie Rajapakse:
Oh, goodness.
Dr. Angela Mattke:
Sign-Out-During-Residency sick, like, all of my residency colleagues knew I was pregnant at, like, seven weeks because I was vomiting everywhere. And the only thing I wanted during pregnancy, the only craving I had was kombucha.
Dr. Nipunie Rajapakse:
Oh, my goodness.
Dr. Angela Mattke:
And fruit. Okay. But you know, kombucha is considered a raw food. And so that's potentially on the don't list because there might be a theoretical risk of potentially having foodborne illness associated with it. But, like, the mom part of me and the person who couldn't keep any food down, the only thing I wanted was kombucha. And I gave up so much. I already am a vegetarian for pretty much my whole life. I exercise; I don't drink alcohol. And I'm like, the only thing I want is kombucha. Just give me a kombucha. And so I did some research on it, and I decided to take a calculated risk. It's probably not the best thing to be saying as a doctor, but I decided I'm gonna have an occasional kombucha so I can stay hydrated because it was the only thing I craved, and I love the fruity ones with like mango; that was my flavor. That's the only thing I wanted. So what I want you to kind of talk about a little bit today – because you are a pediatric infectious disease doctor, and this is your wheel house, so put on the doctor hat, right? – I wanna kind of go into and shed some light on the do's and don'ts. So what are some of the don'ts that we can't do during pregnancy, but also, I guess, first, are you having any cravings?
Dr. Nipunie Rajapakse:
Yes, Angie. So I think this is like one of the maybe most challenging parts. I think we all have that thing that we want to eat or drink during pregnancy. And even though there may be some level of risk associated with it, sometimes it's really hard to give up completely. And I was really interested. Before I was pregnant myself, I kind of just accepted all of the advice that was out there. There are so many things that you hear, and I never really questioned it because a lot of it sounds like it makes sense.
Dr. Angela Mattke:
Yeah, it does.
Dr. Nipunie Rajapakse:
But once I was having to personally make some of these decisions and especially – so my thing was sushi, so I love sushi, and it was really hard to give it up. And the thought of giving it up for nine months was something that I was not just willing to accept on superficial face value of what I was reading online. And kind of thinking through it as an infectious disease specialist, I couldn't really come up with like a super clear justification or why it was so much higher risk than other foods.
Dr. Nipunie Rajapakse:
And then when I was looking into it more, for example, in Japan, sushi is kind of one of the staples of their diet or eating raw fish and looking into it, there are pregnant women in Japan that eat sushi throughout their pregnancy. And so then I was interested in, is there higher risk of certain things? Do they see higher rates of certain infections there? And so the deeper I delved into this, the more I started also thinking about some of the other recommendations out there. So I will say maybe I'll start with sushi because that is near and dear to my heart. In pregnancy, obviously, any sort of foodborne illness, any infection in pregnancy can increase your risk of, for example, things like preterm labor or delivery. So definitely food safety and being careful with food is an important thing that we recommend for everyone. Where it becomes tricky is identifying which foods are higher risk than others. Obviously you wanna have a healthy, balanced diet and make sure your baby gets all of the nutrients. And there are great things in fish like DHA or omega-3 fatty acids for example, that are important for brain development.
Dr. Angela Mattke:
Yes, yes.
Dr. Nipunie Rajapakse:
Exactly. And then especially when it comes to fish, there's also things like mercury, and so that's another aspect to think about in terms of how much and where you're eating it or what types of fish you're eating. From an infectious disease perspective, though, I think one of the things is the types of foodborne illness that we worry about. So specifically, mostly certain types of parasites, the rates are really low in the United States because here for any fish that you serve raw or sushi-grade fish, there's actually a requirement that it be frozen.
Dr. Angela Mattke:
Oh, I didn't know that.
Dr. Nipunie Rajapakse:
Yeah.
Dr. Angela Mattke:
Interesting. Okay.
Dr. Nipunie Rajapakse:
So that really takes care of most of the issues related to parasites now. So my approach, I will say, I have had sushi while I have been pregnant. It's not something I'm planning to eat every day or every week.
Dr. Angela Mattke:
Yeah.
Dr. Nipunie Rajapakse:
But if I really want it, I will eat it, but I'm not gonna go, for example, to a gas station and buy sushi there. I will go to good restaurant place to get it. And I think as long as they are practicing kind of careful food handling practices, I think the risk is low.
Dr. Angela Mattke:
Are you thinking about getting pregnant, or maybe you're a current mom-to-be, or you're like myself and you're in the midst of raising kids and you're looking for practical evidence-based advice from Mayo Clinic experts. Mayo Clinic Press has got you covered. We have a series of four books, starting from "Fertility and Conception" to "Guide to a Healthy Pregnancy," "Guide to Your Baby's First Years." And the last book in this series, the one I was the medical editor of, "Guide to Raising a Healthy Child." You can find these amazing books from Mayo Clinic Press wherever books are sold or on the Mayo Clinic Press website.
Dr. Nipunie Rajapakse:
So the other big ones that we hear about in pregnancy, for example, are soft cheeses and deli meat. I think they're – those are two things that I have avoided. The risk with those relates to a type of bacteria called listeria that for most normal, healthy people, they might get kind of a stomach flu or mild illness, but in pregnancy it can be especially severe and can result in miscarriage, stillbirth, and infection within the newborn as well. That can be life-threatening.
Dr. Angela Mattke:
Absolutely.
Dr. Nipunie Rajapakse:
And so definitely not one that you want to mess around with, but I was also kind of interested in understanding a bit more; it's a relatively uncommon infection. And so I looked back kind of at the listeria outbreaks that have happened over the last 10–20 years, which are easily available online because the CDC investigates them and a report publishes what they find. And I was actually honestly astounded at the variety of different foods to which listeria has been linked.
Dr. Angela Mattke:
Okay. So very familiar. Yeah.
Dr. Nipunie Rajapakse:
With the deli meats and cheeses, but in the last 10–20 years, there have been outbreaks related to cantaloupe. There have been outbreaks related to caramel apples, packaged salads.
Dr. Angela Mattke:
Okay.
Dr. Nipunie Rajapakse:
Sprouts, fresh cheeses. So queso fresco, for example, there have been multiple outbreaks.
Dr. Angela Mattke:
Even though it's pasteurized.
Dr. Nipunie Rajapakse:
Those ones probably are not pasteurized but made with fresh milk, and certain deli products as well. Ice cream was on the list. There was an outbreak related to ice cream.
Dr. Angela Mattke:
Ice cream? You're not taking ice cream away from me.
Dr. Nipunie Rajapakse:
So this is the thing. So when you look at the variety of different things, it's impossible and probably not safe to tell someone to avoid –
Dr. Angela Mattke:
What are you left eating? Just only eating cooked carbohydrates, I guess? I don't know, yeah.
Dr. Nipunie Rajapakse:
Exactly. There are also gonna be downsides to having such a restricted diet in terms of the nutrients you get. So I think we have to be realistic when it comes to these.
Dr. Angela Mattke:
Absolutely. For sure.
Dr. Nipunie Rajapakse:
Raw or unpasteurized milk products we know are high risk. We don't recommend ingesting those. Deli meats, for example, should be cooked to steaming hot. I think those are practical, realistic things for people to do, but other things you may have a bit more leeway with, and it can be quite unpredictable. Thankfully, we have a great food safety system in this country. And if you're worried about certain things, there are places online that you can look to find out the latest. So I think there are so many things to be worried and anxious about in pregnancy. I think we all want to do everything right?
Dr. Angela Mattke:
Yes. Yes.
Dr. Nipunie Rajapakse:
But obsessing about some of these things is probably not helpful as well. And so I've tried to take a bit of a pragmatic or realistic approach as an infectious disease specialist. I look at everything, assess its infectious disease risk, and certain things are higher risk and things are lower risk. There are few things in life that we do that are zero risk.
Dr. Angela Mattke:
Exactly.
Dr. Nipunie Rajapakse:
And so it's kind of judging based on your own risk tolerance and your lifestyle, kind of what you're willing to accept. So those are kind of some of the food-related things. The other foodborne infection that can cause specific issues during pregnancy is a parasitic infection called toxoplasmosis, maybe one that people are familiar with, but not super common as well. And you may not hear so much about it. I think the context that most people hear about it in is related to cats and changing the cat litter.
Dr. Nipunie Rajapakse:
So I think everyone is pretty familiar with that recommendation that pregnant women shouldn't be handling cat litter. But I think people are maybe less familiar with the fact that toxoplasmosis can be found in the environment. So gardening, for example, especially if you have cats or animals in your neighborhood, if you ingest soil bacterias that enter and get under your nails or something like that can be one of the ways you can get toxoplasmosis. And not washing fruits and vegetables, so having dirt contamination of fruits and vegetables and eating them is a probably even more common way to acquire toxoplasmosis than from a cat even. And so I think making sure that you wash produce really well is important and just good hand hygiene if you're doing gardening or other outdoor activities. Toxoplasmosis can also be transmitted through undercooked meat, fish, shellfish as well. And so making sure that you cook those things through, if you're eating them is another kind of way that you can reduce your risk. We see much lower rates here than, for example, in parts of Europe. And so if you're traveling or doing things like that, it's also important to kind of understand what's going on in the places that you're going to.
Dr. Angela Mattke:
The toxoplasmosis is really interesting because I've been using that as an excuse not to change the cat litter for, like, 18 years with my husband. So theoretically I couldn't garden either or do all the things when I'm pregnant. Don't tell my husband about those. Does that sound good? What about caffeine in pregnancy? So I gave up coffee during pregnancy because I just couldn't stand the smell of it. Not because I didn't want it. I still had, you know, caffeine in tea and stuff like that from some time to time. But, like, what's a safe amount of caffeine during pregnancy?
Dr. Nipunie Rajapakse:
Yeah, so this was another one that I was interested in. I am a coffee drinker. I didn't drink a huge amount. I usually had one or two cups a day before I got pregnant. And so, generally, the recommendations now are less than about 200 milligrams of caffeine per day is likely safe. So that's about one or two cups of coffee per day. Different coffee products can have different amounts, so it's important you look at exactly what you're having, see what the caffeine content is. There were some studies that suggested that maybe excess caffeine intake could result in a higher rate of miscarriage. And so, given my age and already being at relatively high risk, I did give it up for the first trimester because it's kind of when the risk is highest. But I have gone back to having one cup a day in the morning. I need it to function at this point. I missed it.
Dr. Angela Mattke:
Yep! Especially because you're exhausted during pregnancy.
Dr. Nipunie Rajapakse:
Yeah. I missed it when I had given it up. And so I decided that was something I was kind of willing to compromise a bit on.
Dr. Angela Mattke:
So the take home message: stay away from like the energy drinks, basically, the things with massive amounts of coffee or caffeine in them, excuse me. Yeah. So do you wanna summarize for us some of the do's and don'ts, of the don'ts list of things that are, like, pretty clear evidence? "Absolutely don't do." And some of the things that are "assess your own risk."
Dr. Nipunie Rajapakse:
Yeah. So I think pretty clear don'ts are avoiding unpasteurized dairy products, avoiding deli meats, unless they're heated, I think is very reasonable. Alcohol is the other one that often comes up on this list as well. And, I think, if you look at the recommendations of all of the major kind of pregnancy or pediatric organizations, they all say there's kind of no known safe level of alcohol during pregnancy. And so, certainly, many women decide to just completely give up alcohol. That being said, I also looked into this a bit more, just to see kind of what the evidence and the data is behind it. Obviously, this is not something that we can do kind of the highest level of clinical trial and randomized people at this point.
Dr. Angela Mattke:
That is not ethical.
Dr. Nipunie Rajapakse:
Cause we do know that high levels of alcohol intake, especially early in pregnancy, can result in fetal alcohol syndrome, which can have lifelong consequences for children. And so they have looked at – there have been some studies that have looked at varying amounts. And when you look at practices across the world, especially different parts of Europe, there are kind of different philosophies about alcohol intake. And in some countries, it is not unusual for pregnant women to have a glass of wine or something like that. And so, even though we can't do like a randomized trial, we do have this kind of natural experiment of different parts of the world kind of doing different things and being able to follow the outcomes. And generally, most of those studies have been pretty reassuring when it comes to low levels of alcohol intake during pregnancy. So a glass a day or less generally has been kind of the cutoff that they've used in that those children don't seem to suffer major untoward effects in terms of their development. But because the threshold has not been kind of firmly established, if you want zero risk, then the recommendation is to not have any alcohol during pregnancy, which I think is a reasonable thing and many people choose to do that.
Dr. Angela Mattke:
Anything else that you wanted to add in the don't list?
Dr. Nipunie Rajapakse:
I think just, like, common sense things that we would recommend for everyone. So it's summer now, people are doing, obviously, things like a lot of grilling outside. And so making sure that you're following all the foodborne illness precautions in general is probably the most important piece of advice. You're much more likely to get sick from something routine that doesn't necessarily pertain to your pregnancy in specific. And so, following that advice is really important.
Dr. Angela Mattke:
Thanks everyone for joining today. Make sure you don't miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoy this episode and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We'll see you next time.