Can You Eat Sushi While Breastfeeding?

If you love sushi but fought the urge to indulge during pregnancy, you may be wondering if it’s safe to cave to your craving now that you’re breastfeeding your baby.

In short, it’s okay to eat raw fish, even if you’re nursing a little one. But you do need to be careful about your choices.

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You don’t want to end up with food poisoning while caring for a newborn just because you got hold of some bad sushi. Breastfeeding moms also need to avoid certain varieties of fish known to be higher in mercury, a toxin that can harm a developing baby’s brain and nervous system.

So if you’re thinking about ordering takeout sushi, here’s what to know about eating raw fish, as well as the best types of fish to eat when you’re nursing and how to guard against foodborne illnesses.

Why shouldn’t pregnant women eat sushi?

Sushi is off-limits during pregnancy for two reasons:

1. Raw and undercooked seafood can harbor harmful bacteria, viruses and parasites.

Consuming fish that hasn’t been thoroughly cooked can sicken moms-to-be and endanger their unborn babies. Of particular concern is a type of bacteria called listeria monocytogenes. It can cause listeriosis, a potentially serious foodborne illness.

While listeria infection is rare, pregnant women are 10 to 20 times more likely to become infected than the general population.

A pregnant woman who eats fish contaminated with listeria can spread the bacteria to her baby through her bloodstream. If the infection isn’t treated, her baby can develop life-threatening complications. The illness poses risks, including miscarriage, preterm labor and low birth weight.

That’s why the U.S. Department of Health and Human Services recommends that pregnant women avoid raw seafood. You’ll want to avoid these fish dishes during pregnancy:

• Sushi
• Sashimi
• Raw oysters
• Raw clams
• Raw scallops
• Ceviche
• Refrigerated smoked seafood, including lox (unless thoroughly cooked)
• Salted or pickled fish, including gravlax (unless thoroughly cooked)

2. Some sushi contains fish that have higher mercury contamination.

Mercury is a heavy metal that accumulates in the flesh of fish. Larger and older fish tend to have more of it — they’ve been exposed to it for a longer period of time.

Eating higher-mercury seafood while you’re pregnant or trying to conceive is a big no-no. Once it enters a woman’s bloodstream, it can pass from mom to baby through the placenta.

Since mercury can harm a little one’s developing brain and nervous system, pregnant women should avoid eating fish known to have higher levels of this toxin. (See the list of culprits below.)

Can you eat sushi if you’re breastfeeding?

Now that your baby is nursing, your postpartum diet can include sushi, but you’ll want to pay attention to the quality and types of sushi you’re eating.

Breastfeeding babies are not at risk of developing listeria via breast milk, so go ahead and get your sushi fix, but stay away from sketchy places where the fish may not be as fresh as it should be. The last thing a new mom needs is a fever or a vicious case of diarrhea from eating tainted fish.

The warning about mercury in fish also applies to lactating moms. Mercury can pass from mom to baby, albeit in smaller amounts, through breast milk.

That shouldn’t stop you from nursing. As the Centers for Disease Control and Prevention (CDC) points out, the benefits of breastfeeding your baby are likely greater than the possible risk of mercury exposure. Fish, after all, is a protein that supplies beneficial omega-3 fatty acids that support your baby’s developing brain.

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Still, it makes sense to be vigilant. In its advice to nursing moms, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) identify seven varieties of fish to avoid due to their high mercury content.

Do not eat these types of fish if you’re breastfeeding:

• Shark
• Swordfish
• King mackerel
• Tilefish (from the Gulf of Mexico)
• Marlin
• Orange roughy
• Bigeye tuna

You’ll also want to limit how much you eat of a couple more types of fish, per the American College of Obstetricians and Gynecologists (ACOG), including:

• Albacore (white) tuna. Eat no more than 6 ounces per week.

• Certain fish caught in local waters. In the absence of advisories on mercury or other pollutants, play it safe by limiting your consumption to 6 ounces in a week, and don’t eat any other fish that week.

Also note: Many freshwater fish aren’t safe to eat raw. Saltwater varieties are usually better. To reduce your mercury exposure while you’re breastfeeding, opt for sushi prepared with low-mercury fish. (See a list of some recommended options below.)

What are the best types of fish for breastfeeding women?

Fortunately, there are lots of lower-mercury seafood options that are safe for breastfeeding women. ACOG actually encourages breastfeeding moms to eat 8 to 12 ounces of fish a week. That works out to be roughly two to three servings per week.

The FDA and EPA’s “best choices” list of low-mercury fish is extensive. It includes:

• Atlantic mackerel

• Black sea bass

• Cod

• Crab

• Flounder

• Herring

• Lobster

• Oysters

• Pacific chub mackerel

• Perch

• Salmon

• Scallops

• Shrimp

• Sole

• Tilapia

• Trout (freshwater)

• Canned light tuna

• Whitefish

In addition, there are a number of “good choices” that tend to be somewhat higher in mercury. The FDA and EPA’s list includes varieties such as halibut, striped bass, snapper and albacore tuna. If you choose to eat from this list, limit your fish intake for the week to no more than one 4-ounce serving.

How to protect yourself from foodborne illnesses when pregnant or breastfeeding

Anyone can get food poisoning, but pregnant women are especially vulnerable. Immune system changes during pregnancy can put moms-to-be and their unborn children at risk. If you’re expecting, it’s best to skip the sushi bar completely.

Nursing moms have a little more leeway and can eat sushi cautiously. Still, it’s important to recognize that raw or undercooked seafood can make anyone sick.

Here are a few tips to keep everyone safe:

• Wash up. If you’re in the kitchen, you need to scrub your hands with soap and water before handling any type of fish or seafood. And you should always wash your hands before you eat.

• Buyer beware. Choose freshly prepared sushi and seafood. Shop at markets and frequent restaurants known for the quality of their seafood as well as their safe food-handling practices.

• Break out the ice. Cold seafood should be kept chilled until it’s time to eat. Serve it over ice if it’s going to sit out longer than two hours.

• Store seafood properly. Refrigerate cooked fish and shellfish after two hours at room temperature (or one hour if you’re eating in 90 degree or warmer weather).

• Do the dishes. Wash any knives, cutting boards, dishes or other utensils used to prepare raw fish with soap and hot water before using them again.

Or maybe you’d rather have a trained sushi chef prepare your meal. If that’s the case, be sure to do your homework first. Pick a restaurant with an excellent reputation, and enjoy yourself. You deserve it!

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