Food safety in pregnancy - Pregnant women have lower levels of immunity than usual and may be more at risk of getting diseases carried by food.
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Food safety in pregnancy Pregnant women have lower levels of immunity than usual and may be more at risk of getting diseases carried by food. This booklet provides advice and guidance on what you can do to avoid dangerous food bugs.
Higher risk foods to avoid when pregnant • Chilled ready-to-eat foods such as those bought from a supermarket deli or restaurant buffet unless they are heated until piping hot. • Prepared ready-to-eat foods such as store-bought sandwiches where you can’t be certain of product age, storage conditions, or the preparer’s food handling practices. • Soft and semi-soft pasteurised cheese e.g. brie, camembert, feta, blue, mozzarella, ricotta. • Raw milk (unpasturised), raw milk cheeses and raw milk yoghurts. • Cold cooked or smoked chicken. • Processed meats such as ham, pâté, salami or luncheon. • Prepared salads including rice or pasta salad, coleslaw, roasted vegetable and green salads. • Raw or smoked seafood including sushi, smoked salmon, marinated mussels, or oysters. • Raw eggs e.g. in smoothies, mayonnaise or desserts like mousse. • Soft serve ice cream. • Cream or custard especially in pre-made cakes or pastries (unless newly opened or home-made and fresh). • Hummus and other dips containing tahini (which has been linked to both Salmonella and Listeria infection). ACKNOWLEDGEMENT: We are grateful to Dr Cathy Pikholz and Dr Greg Simmons for the original development of this resource in association with antenatal educators and pregnant women in Auckland.
Why safe food is important in pregnancy Although New Zealand In extreme cases, bugs found in food can cause miscarriage, still or premature birth, and serious illness or even death to has one of the safest newborn babies. But even less severe cases of foodborne food supplies in the illness can sideline you from the task at hand – developing a healthy baby. world, expectant mothers need to take The good news is that by taking some basic food safety steps you can prevent most foodborne illness. If others in your extra precautions house help with the cooking and shopping, ask them to follow around food – to protect these tips too. their own health and Information on the nutritional needs and healthy eating for pregnant women is in the Ministry of Health’s booklet Eating the health of their for Healthy Pregnant Women (www.healthed.govt.nz). developing baby. During pregnancy, Food safety in a nutshell your immunity is • Wash and dry your hands thoroughly. lower so you and • Be FoodSmart: clean, cook, chill. your unborn baby are • Avoid high risk foods (see our pullout guide). more susceptible than usual to the kinds of foodborne illnesses that affect everyone. 1
Foodborne illnesses to avoid Washing and drying Listeria and Toxoplasma are two infections you can get through food which are rare but particularly dangerous when your hands properly you are pregnant. is one of the most Listeria is a bacterium found in the environment, including in animal faeces, on plants, in soil and in water. As a result, effective things you Listeria can occur on raw food or contaminate prepared food. can do to prevent Unlike most bacteria, Listeria can grow on food in the fridge. The disease caused by Listeria – listeriosis – may cause foodborne illness. miscarriage or early labour or the baby may be born with the infection and need treatment with antibiotics. To avoid listeriosis: • avoid eating higher risk foods (see box on inside front page or pull-out guide) • wash or cook food thoroughly • keep to ‘use by’ and ‘best buy’ dates and store food at the recommended temperatures • eat packaged perishable foods within a couple of days of opening. 2
TOP TIP Toxoplasma infection can occur through cross-contamination after gardening where cats have deposited their faeces, or Symptoms of through direct contact with cats. It can also come from eating foodborne illness unwashed vegetables, undercooked meat, or drinking raw or unpasteurised milk and ready-to-eat cured meats such Most types of foodborne illness have fairly similar symptoms. as salami and ham. The disease caused by toxoplasma – toxoplasmosis – may cause eye or brain damage in your See your doctor as soon as unborn baby. possible if you have any of the following: • nausea To avoid toxoplasmosis: • vomiting • wash your hands after handling raw • diarrhoea meat and vegetables and after gardening • stomach pain • ask someone else to empty your cat’s litter tray, or • headache wear gloves to do it • swollen glands • wash and dry hands well after touching or cleaning up after animals. • flu-like symptoms including fever and muscle aches. Some other common foodborne illnesses to watch out for: Campylobacter is a bacterium commonly found in animals and the environment. Campylobacteriosis is New Zealand’s most commonly reported foodborne illness. In pregnancy it may cause miscarriage and premature labour. Salmonella is a bacterium quite commonly found in raw meats, poultry, raw (unpasteurised) milk and raw milk cheeses and yoghurts, seafood, fresh produce (including sprouts), and foods such as kebabs and sandwiches handled by infected foodhandlers. Salmonellosis is New Zealand’s second most commonly reported foodborne illness. In pregnancy it can cause stillbirth on rare occasions. 3
Be FoodSmart during your pregnancy Follow these basic Clean FoodSmart steps to • Wash and dry your hands thoroughly before and after preparing food and especially after handling raw meat and help reduce the risk poultry, using the toilet or helping a child to go to the toilet, covering a sneeze or a cough, changing nappies, touching of bacteria pets, and gardening. multiplying on food, • Use clean tea towels and hand towels. or spreading from • Use different coloured cloths for the dishes, the bench and the floor or use paper towels and disinfectant to wipe one type of food up raw meat juices or floor spills. • Use separate chopping boards and utensils for raw meats to another. and cooked or ready-to-eat foods (e.g. salad) – or wash the chopping board well between uses. • Put cooked food onto a clean plate, not the one you used when the food was raw. • Change your dish cloths or sponges regularly and clean them by: washing in hot water, soaking in bleach solution for at least one hour, wetting then microwaving for 2 to 4 minutes on high, or putting through a full cycle in the dishwasher. • Cover food to protect it from flies or cross-contamination from raw meat juices. Microwaving • Stir food to avoid uneven cooking which leaves cold spots where bugs can survive. • Cover food as this allows it to cook or thaw more evenly. • Leave food for the recommended standing time so it finishes cooking. 4
TOP TIP Cook • Defrost food in the fridge overnight or on the defrost setting in the microwave and make sure it’s defrosted right through before cooking. • Preheat the oven so that food cooks as quickly as possible. • Keep raw and cooked foods separate. • Cook or reheat food thoroughly. Cook chicken, mince and sausages right through – the only way to be really sure is to use a meat thermometer to check they are cooked to Clean the safe internal temperature of 75°C. • Marinate food in the fridge and cook the marinade before pouring it over cooked food. • Eat cooked food while it is still hot – don’t leave it to stand at room temperature for more than two hours. • Reheat leftovers until piping hot (over 70ºC) and do not reheat more than once. Chill • Fridges should be between 2ºC and 4ºC. If you overload the fridge or open it often, it will have difficulty Cook staying cold. • Freezers should be between –15ºC and –18ºC ie, cold enough that the food is frozen solid. • Cover food before putting in the fridge or leaving out for serving – food can be covered and left at room temperature for up to two hours before it should be eaten, reheated right through, put back in the fridge, or thrown out. • Cover and store raw meat on the bottom shelf of the fridge so juices don’t drip on other food. Chill 5
Be FoodSmart during your pregnancy Eating well during Wash your hands your pregnancy is Washing and drying your hands properly is one of the most effective things you can do to prevent foodborne illness. essential, but it’s Drying is just as important as washing. also important to • Wash + dry = clean. eat safely. • Wash your hands thoroughly, using plenty of soap. • Rinse them well. • Dry hands well on a clean, dry hand towel or paper towel. • Keep hand towels for hands only, or use paper towels – don’t use the tea towel. • Use a fresh hand towel daily (and change it more often if it is dirty). Buy safe food Food that has passed its “use by” date is not safe to eat and it is illegal to sell it. Food may be sold and eaten after its “best by” date but we don’t recommend this for pregnant women. Don’t buy: • food in damaged packets or tins or in loose vacuum packs – vacuum packaging should be tight around the food, with no air pocket • chilled products that are not cold to the touch • frozen products that are not frozen solid • hot foods that are not piping hot (e.g. cooked chicken). 6
TOP TIP Store food safely • Keep food in covered containers and store as Take food home safely recommended by the manufacturer. • At the supermarket, make sure • Eat food before the “use by” and “best by” dates and raw meat and chicken are within two days of opening the package or container. packed separately from the • Throw away food that has passed its “use by” date. rest of your groceries to stop • Use food within two days of opening the package cross-contamination from raw or container. meat juices. • Keep your fridge between 2°C and 4°C. • Take food straight home or • Leftover hot food should be covered and put in the fridge transport it in a chilly bin then as soon as it has stopped steaming; hot food will cool more put it into the fridge or freezer quickly if put into a shallow covered dish in the bottom of right away – never leave food the fridge where it is colder. in a hot car or sitting around waiting to be put away. • Throw out leftovers after two days and never freeze food more than once. • Only drink treated water. Canned foods Other foods that are usually safe to eat are those that are shelf- stable (i.e. able to be stored in the pantry rather than the fridge) or canned. Shelf-stable foods can be kept unopened at room temperature for a long time and are not usually a risk for Listeria, provided they are stored and used as per the manufacturer’s instructions. Canned foods such as canned tuna and chicken receive heat treatment which removes bacteria, and the packaging will prevent others from growing. However, once the food has been opened, it is important to consume it immediately. 7
When eating raw foods or eating out The principles of Foods that are eaten raw food safety are the • Fruits and vegetables may harbour dirt, insects or residues from sprays. Thoroughly wash produce in safe (treated) same for raw foods water. and takeaways as • Raw shellfish. Don’t eat raw shellfish and foods made with raw fish, such as sushi. These can sometimes contain they are for foods harmful bacteria and viruses. prepared at home. • Milk and milk products (e.g. milk, cheese, and yoghurt) are important sources of protein and calcium during pregnancy. Most milk products sold in New Zealand are pasteurised, which greatly reduces the risk of bugs that can make you sick. Ideally, they should be consumed within two days of opening, or can be used as an ingredient in cooked foods if older than two days. Don’t eat raw (unpasteurised) milk and raw milk cheeses or yoghurts. • Soft, pasteurised cheeses (e.g. brie, camembert, blue, ricotta, mozzarella and feta) should generally not be eaten uncooked while you are pregnant. However, if you’ve bought them in the manufacturer’s original packaging, they can be eaten in small quantities immediately after opening. Do not reseal and eat them later, and do not eat if they have been cut and repackaged in a deli or supermarket as they may have become contaminated. 8
TOP TIP Restaurants, cafes and takeaways Overseas travel The principles of food safety are the same for takeaway foods as they are for foods prepared at home. Some countries have extremely high rates of foodborne illness, and • Piping hot food, well-done meats and foods that have water supplies may not be safe. been well-cooked immediately before eating can be • Take special care that food considered safe, e.g. cooked-to-order meals, deep fried (especially meats, pre-prepared and baked foods, or hot freshly-made pizza. Hot soup is a or ready-to-eat foods, and healthy alternative that is generally safe to eat. uncooked, peeled fruit and • Don’t eat high-risk foods such as sushi, salads salads) and water (including and sandwiches (see Higher risk foods to avoid when ice) is safe to eat and drink. pregnant on inside cover). • Pregnant women should seek advice from their doctor, a • Avoid buffets or smorgasbords where food may have been local public health unit or sitting uncovered, allowed to cool, or contaminated by travel health clinic before other people. travelling overseas. 9
In pregnancy you need more… Folate is found Folic acid naturally in • Before you get pregnant and during the first trimester of pregnancy you need an increased amount of folic acid, a food – especially B vitamin which helps form your baby’s blood cells and nerve tissue. If you don’t get enough folic acid your baby green vegetables has a higher risk of developing neural tube defects such and grains. as spina bifida and anencephaly. • Folate is found naturally in food – especially green vegetables and grains. Folic acid, which is the synthetic form of folate, is voluntarily added to some foods, e.g. some breakfast cereals and some bread. However, it is hard to get enough folate or folic acid from your diet, so the Ministry of Health recommends you take a folic acid tablet. • For at least four weeks before you conceive and for the first 12 weeks of pregnancy you should take a registered 800 microgram folic acid tablet daily. Women with a family history of neural tube defects may be advised to take a higher dose of folic acid. Check with your doctor or midwife to find out what is best for you. • Folic acid tablets are available from pharmacies or on prescription from your midwife or doctor. If you find out that you are pregnant and have not been taking folic acid tablets, you should start taking one immediately. 10
TOP TIP Iodine • During pregnancy and while breastfeeding you need an A subsidised iodine- increased amount of iodine, which is essential for the growth only tablet (containing and development of your baby. Iodine occurs naturally in most foods although usually in small amounts, so it is 150 micrograms) important to take an iodine-only tablet and choose foods that are rich in iodine but also safe for you and your baby. specifically made • Choose foods that are good sources of iodine e.g. lowfat milk for pregnant and products, eggs, cooked fish and some shellfish, home made sushi and most bread. Refer to the pull-out guide in this breastfeeding women booklet for additional information on the types and amounts of fish and shellfish that can be safely consumed during is available from pregnancy. pharmacies or on • Iodised salt will provide some iodine in your diet if used instead of non-iodised salt in cooking or at the table. Most prescription from your commercially prepared bread has iodine added to it through doctor or midwife. the use of iodised salt. • A subsidised iodine-only tablet (containing 150 micrograms) specifically made for pregnant and breastfeeding women is available from pharmacies or on prescription from your doctor or midwife. Other iodine supplements (including seaweed and kelp supplements) are not recommended as the iodine content in some of these products is extremely variable and there are risks from having too much iodine. • Care must be taken when choosing foods containing brown seaweed, such as kelp, kombu, wakame, quandi-cai, hiziki/hijiki, arame or Sargassum fusiforme which contains naturally high and varying levels of iodine. If brown seaweed is consumed regularly, the levels of iodine can be too high for pregnant and breastfeeding women. It is recommended that pregnant and breastfeeding women eat no more than one serve a week of brown seaweed. • If you have any concerns about iodine intake, talk to your midwife or doctor about what is best for you and your baby. 11
In pregnancy watch out for… Mercury Caffeine Cooked fish is a healthy food for you and There is evidence that caffeine consumption your growing baby. Fish is low in saturated may affect your baby’s growth during fat and an excellent source of protein, pregnancy. Caffeine is naturally occurring essential omega-3 fatty acids, iodine and in tea, coffee and chocolate, and is present some vitamins. Omega-3 is important for the in many cola‑type soft drinks. Limit your development of the central nervous system. consumption of caffeinated drinks while pregnant. Energy drinks and shots, which Mercury occurs naturally in the environment may contain high levels of caffeine, are not and accumulates in the aquatic food chain recommended for pregnant or breastfeeding as methyl-mercury, so all fish contain some women. Be cautious about drinking herbal methyl-mercury. If you are pregnant or teas. Discuss this with your doctor or midwife. considering pregnancy, keep your exposure within safe limits by eating fish species that have lower levels of mercury, and eat Brown Seaweed a variety of fish where possible. Most of the Be careful when choosing foods containing commonly eaten fish species in New Zealand brown seaweed. Brown seaweeds are can be eaten freely. See the pull-out guide typically sold dry and are used in soups for recommended servings for various and stewed dishes, kelp salt and seaweed fish species. salads. Brown seaweeds, such as kelp, kombu, wakame, contain naturally high and Cadmium varying levels of iodine. If brown seaweed is consumed regularly the high levels of Bluff oysters and queen scallops have high iodine can be too high for pregnant and cadmium concentrations. We recommend breastfeeding women. It is recommended you minimise your intake (regardless of how that you eat no more than one serving of they are prepared) during pregnancy. brown seaweed a week. See the pullout guide for a larger list of brown seaweeds. Nori is a green seaweed which is also sold dried and used in many seaweed-containing products. Unlike brown seaweed, it contains safe levels of iodine, so is not restricted to one serving a week. 12
Alcohol It is safest to avoid alcohol during pregnancy or if you are trying to get pregnant. Alcohol crosses the placenta so the foetus is affected by whatever the mother consumes. Excessive alcohol consumption is linked to foetal alcohol syndrome, which may damage your baby’s brain. Even if the mother drinks only small amounts, her baby may show behavioural and learning difficulties linked to alcohol. More information… Visit: www.foodsmart.govt.nz
www.foodsmart.govt.nz Ministry for Primary Industries PO Box 2835 Wellington 6140 NEW ZEALAND 0800 00 83 33 ISBN: 978-0-478-40521-7 (Print) ISBN: 978-0-478-40520-0 (Online) Revised January 2013 DISCLAIMER Every effort has been made to ensure the information in this guide is accurate. MPI does not accept any responsibility or liability whatsoever for any error of fact, omission, interpretation or opinion that may be present, however it may have occurred.
Pull-out guide to food safety in pregnancy FOOD TYPE WHAT TO DO Breads and cereals Breads all types OK to eat Cakes, slices, muffins etc • plain OK to eat • with added cream or custard Don’t eat (unless cream is newly opened and custard is home-made and fresh) Cereals breakfast cereals, rice, pasta etc OK to eat – refer to milk and milk products below Milk and milk products • soft unpasteurised (raw milk) cheese Cheese Don’t eat (e.g. Roquefort) Generally should not be eaten uncooked while pregnant. However, OK to eat • soft pasteurised cheese in small quantities if purchased in the manufacturer’s original packaging and • (e.g. brie, camembert, blue, ricotta, mozzarella, eaten immediately after opening. Do not reseal to eat later, and do not eat if feta) they have been repackaged in a deli or supermarket as they may have become contaminated • hard cheese (e.g. cheddar, parmesan) OK to eat, store in fridge • cottage cheese, cream cheese etc Buy in sealed packs; eat cold or cooked within two days of opening pack Butter all types Ok to eat, store in fridge fresh, unwhipped or whipped, Cream Buy in sealed packs; eat within two days of opening pack sour cream etc Custard • ready-made chilled (packaged) Eat within two days of opening Eat hot immediately after cooking; reheat leftovers until piping hot (over 70ºC) • home-made and eat within two days Milk • pasteurised Ideally drink or use within two days of opening • unpasteurised (raw) Don’t drink or use Ice cream • packaged OK to eat • soft serve Don’t eat Yoghurt • pasteurised Ideally eat within two days of opening • Unpasteurised (raw) Don’t eat Eggs in egg flips, eggnog, smoothies, home-made Raw eggs mayonnaise and dressings, home-made ice Don’t eat cream, mousse and tiramisu etc Cooked eggs fried, scrambled, baked, poached, etc Cook well (firm yolks, firm scrambled eggs) Meat and poultry Cook until piping hot throughout, and until juices run clear (use a meat thermometer to check temperatures); eat while hot; never eat rare or Cooked meats beef, pork, chicken, mince, sausages etc undercooked meats; store leftovers covered in fridge and eat within two days; reheat leftovers until piping hot (over 70ºC) ham, salami, luncheon, pâté, pastrami, biltong, or Processed meats Don’t eat unless heated until piping hot jerky (dried meat) etc Cold cooked poultry any cold pre-cooked poultry (e.g. chicken, turkey) Don’t eat unless heated until piping hot any raw meat, raw chicken or other poultry, Don’t eat or taste; don’t touch face, mouth or eyes while preparing; wash and dry Raw meat beef, pork etc hands well after touching raw meat Seafood Raw fish any raw fish (including marinated raw fish) Don’t eat any raw shellfish (including marinated raw Raw shellfish Don’t eat mussels) Smoked fish, chilled, pre-cooked fish, mussels, oysters*, Don’t eat unless heated until piping hot shellfish and crustacea scallops*, salmon, crayfish, prawns etc FOOD TYPE WHAT TO DO Vegetables, salads and fruits Fruit all fresh fruits Wash and dry well just before eating Vegetables • all fresh vegetables Wash and dry well just before eating raw, or wash before cooking • frozen vegetables Cook; don’t eat uncooked frozen vegetables • ready-made salads and coleslaws from delis, Salads Don’t eat salad bars etc • home-made Wash salad ingredients well before using Herbs fresh home-grown and store-bought Wash well before using Miscellaneous Store leftovers covered in fridge and eat within two days; reheat leftovers until Leftovers cooked foods piping hot (over 70ºC); never eat cold leftovers canned fruit, vegetables, fish, seafood, meat, Eat immediately after opening tin (hot or cold); store uneaten leftovers covered in Canned foods sauces etc fridge and eat within two days; remove from can for storage salad dressings (oil and vinegar), bought Sauces, dressings mayonnaise, tomato sauce, margarine-type Store in fridge once opened; check maximum storage time and spreads spreads etc • store-bought (all types – even without raw Sushi Don’t eat seafood) Use freshly cooked rice, and don’t use raw or cold cooked meat or seafood; eat • home-made immediately; don’t eat leftovers Don’t eat unless stuffing is cooked separately (in a dish); eat hot; store leftovers Stuffing stuffing from chicken or turkey in fridge and eat within two days; reheat leftovers until piping hot (over 70ºC) Hummus and tahini store-bought or home-made Don’t eat • Brown seaweed** (i.e. kelp, kombu, wakame, Limit to 1 serve per week arame, quandai-cai, hiziki/hijiki, or Sargassum Seaweed fusiforme) • Red or green seaweed (including nori and Ok to eat, see advice on sushi karengo) used in sushi and dulse * Bluff and Pacific oysters and queen scallops have high cadmium concentrations. We recommend you minimise your intake (regardless of how they are prepared) during pregnancy. **Brown seaweeds contain naturally very high iodine concentrations. Brown seaweeds are typically sold dry and are used in soups, stewed dishes, kelp salt and seaweed salads. Recommended servings for fish species to minimise mercury intakes No restriction necessary Anchovy • Arrow squid • Barracouta • Blue cod • Brill/Turbot • Brown trout (except from Lake Ellesmere) • Cockles • Eel, long or short finned • Elephant fish • Flounders • Gurnard • Hoki • John Dory • Monkfish or stargazer • Mussels (green and blue) • Orange perch • Oysters (except Bluff and Pacific) • Parore • Scallops (except Queen) • Rainbow trout (only from non- geothermal regions) • Skipjack tuna (No data for yellowfin tuna) • Sole (except Lemon sole) • Southern blue whiting • Surf clams (e.g. tuatua) • Tarakihi • Toothfish, Antarctic • Warehou (common, silver and white) • Whitebait (Inanga) 3 – 4 servings per week acceptable Albacore tuna • Alfonsino • Bass • Bluenose • Gemfish • Ghost sharks • Hake • Hapuka (Groper) • Javelin Fish • Kahawai • Kingfish • Lake Taupo trout • Leatherjacket • Lemon sole • Ling • Mackerel (blue and jack) • Orange Roughy • Oreo dories • Red cod • Ribaldo • Rig (Lemonfish, Spotted dogfish) • Rock Lobster • Salmon (farmed) • Sea perch • Silverside • Skate • Smooth oreo • Snapper • Sprats • Trevally 1 serving per 1 – 2 weeks acceptable Cardinal fish • Dogfish (excluding rig) • Lake Rotomahana trout • Lake trout from geothermal regions • School shark (Greyboy, Tope) • Marlin (striped) • Southern bluefin tuna • Swordfish
Restaurants and takeaways When you eat out or buy unwashed vegetables soft cheeses Do not eat: pre-prepared salads (unless cooked) takeaways, you should avoid • raw eggs or foods the same high-risk foods containing raw eggs you would avoid at home. (such as mayonnaise, Steaming hot food is your hollandaise sauce, Caesar best choice. However, you dressing, some desserts) have little control over the unwashed fruits foods containing raw eggs, undercooked seafood • unwashed fruits and way food is prepared in vegetables, raw sprouts, restaurants and takeaways. raw herbs • pre-prepared cold When eating in a foods such as salads, restaurant or eating pre-prepared cold foods such unrefrigerated sandwiches undercooked or raw meat takeaway food: as salads, sandwiches or sushi • your food should be well • undercooked or raw meat, cooked and prepared just poultry or seafood before it is served to you • cold meats, pâté or cold, • eat food that is smoked fish cold meats, pâté steaming hot or cold, smoked fish undercooked poultry • soft cheeses (unless • avoid eating from buffets, cooked) • smorgasbords, salad bars or • soft-serve ice cream. from street vendors, as the risks are harder to manage. interpretation or opinion that may be present, however it may have occurred. does not accept any responsibility or liability whatsoever for any error of fact, omission, Every effort has been made to ensure the information in this guide is accurate. MPI DISCLAIMER Revised January 2013 ISBN: 978-0-478-40520-0 (Online) ISBN: 978-0-478-40521-7 (Print) 0800 00 83 33 NEW ZEALAND Wellington PO Box 2526 Ministry for Primary Industries Pull-out guide to Food safety in pregnancy
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