One of the most common questions we get from our patients at an initial pregnancy visit is some version of, “What should I eat/avoid eating while I’m pregnant?”New moms get inundated with warnings about foods that are dangerous for pregnancy from their friends with kids, well-meaning relatives, pregnancy blogs, and the media. This leaves some women fearful and wondering what is available for them to eat that is safe.A well-balanced diet is one of the foundations of good health. During pregnancy, it is important to have adequate macronutrients, vitamins, and minerals to ensure that you are healthy and that your baby has the nutrition he or she needs to grow and thrive.One of the first misconceptions I want to dispel about how to eat healthfully during pregnancy is that you are not “eating for two.”While I’m all for the occasional indulgence in your pregnancy cravings, you do not need to get into eating contests with the man in your life. Don’t let well-intentioned loved ones pile your plate high with double portions because they think you need to eat more.During the first trimester, your caloric intake does not have to increase significantly. In the second and third trimesters (28 weeks and beyond), 350-450 kcal per day will meet the nutritional requirements for your baby. That’s essentially a small meal or a couple of snacks in addition to your regular meals.The foods you do choose should have quality calories that are rich in nutrients…a Slurpee or some powdered donuts, while delicious, may provide calories but are completely lacking in anything but simple sugar. Unprocessed or minimally processed foods such as lean meats, fresh fruits, and vegetables, and whole grains are going to be most densely packed with proteins, good fats, fiber, complex carbohydrates, vitamins, and minerals. These elements are the important building blocks you and your baby need to build and repair tissues and organs like muscle, bone, blood, and brain.Regarding what foods to avoid, I want to stress that we do not want your pregnancy to be a time when you are anxious about eating outside of your home. It is good for you to be with the people you care about celebrating this exciting time in your life. That may involve eating in other people’s homes or at restaurants where you have less control of food preparation. Know that everything will probably be fine. Just think of the number of times you have eaten out in your lifetime compared with the number of times you have gotten sick from any of the foods that you have eaten. The same principle applies now. While there are some precautions with food choices and preparation that are wise to take, please do not let these recommendations make you overly concerned.Basic Guidelines for Food Handling and SafetyFood can be contaminated by a variety of bacteria, parasites, and environmental toxins, and these general guidelines on the safe handling of food to prevent or reduce food-borne illnesses can be recommended to anyone, pregnant or not. We are more focused on the safety of food in pregnancy for a couple of reasons. First, pregnancy is a state of relative immunosuppression.The immune system is designed to identify any cells or parts of cells that do not belong to you and mount a response to get rid of them. In order for your immune system to tolerate you harboring another human for 9 months, it has to be toned down a bit.Consequently, you are more susceptible to illnesses, you may stay sick longer than you normally would, and infections you might typically fend off without difficulty can become more troublesome in pregnancy.Secondly, there are certain bacteria and parasites found in some types of foods that could potentially infect your baby if you ingest them.In general, wash all of your fresh fruits and vegetables even if they have a rind, wash your hands before preparing food, clean your kitchen counters, knives, cutting boards regularly, especially after preparing raw meats, and cook meats and poultry to their safe internal temperatures: Chicken 165° F, Turkey 180° F, Pork 145° F, Beef 160° FRaw Meat Most people in the United States cook pork and poultry thoroughly so I don’t think this recommendation should represent a change to anyone’s diet. Beef, is another story, and there are many different personal preferences for how people like their steaks and burgers cooked.Given the preparation process for ground beef, I would certainly recommend eat your hamburgers medium well to well done. For steak, especially in a nice steak house, medium to medium well should be safe.Seafood Uncooked or smoked/lightly cooked seafood should be avoided in pregnancy. Certain infections from bacteria and parasites can be contracted by eating raw fish and undercooked fish.The FDA does require specific food handling and inspection for fish that is intended to be eaten raw to kill parasites and reduce bacteria to make it safer.However, it is still prudent to avoid sushi altogether. Cold smoked seafood does not reach high enough internal temperatures to kill bacteria like Listeria so I would also pass on lox and other cold smoked fish as well. You can eat shellfish while pregnant, but it needs to be cooked. Oysters, clams, and mussels, although mouthwatering when undercooked, should be avoided.Mercury exposure is another concern associated with the consumption of seafood. Mercury is an element that is present as a contaminant in the ocean and, as a result, can be found in trace amounts in many species of fish.There are plenty of fish have little or no mercury, but a few types carry unacceptably high amounts of mercury – these are mostly larger predatory fish. Mercury exposure for a baby during pregnancy can impact neurocognitive development.Most fish are perfectly healthy to eat. In fact, we encourage you to about 6-12 oz fish per week. There are some fish that are off limits because of their potentially high mercury content.Fortunately, these fish are not particularly common in a Western diet. They include shark, swordfish, marlin, king mackerel, tile fish, orange roughy, and bigeye tuna.Other types of tuna are acceptable to eat, but tuna can have a greater mercury content than some other species of fish and you should limit to about 1 serving per week. Any other fish or shellfish are yours to enjoy if properly cooked.Listeria Listeria monocytogenes is a species of bacteria that exists in soil, water, and in some animals, and it can be problematic if contracted during pregnancy. Pasteurizing and cooking meats to their safe internal temperatures will kill Listeria.These bacteria are unique in that they are able to grow at lower temperatures than many other types of bacteria. Potential food sources of Listeria are unpasteurized dairy, unwashed vegetables, undercooked and smoked seafood, unpasteurized soft cheese, and many types of refrigerated ready-to-eat foods.Avoid picking up salads with turkey, ham, or eggs from the ready-made cold case. You can eat ready-to-eat meats like deli meat, hot dogs, sausages but only if they are heated to “steaming hot” just prior to eating them.Some soft cheeses are not pasteurized. If you like soft cheeses like feta, blue cheese, Gorgonzola, Brie, Camembert, queso fresco, etc, make sure that you look at the label and ensure that the cheese has been pasteurized.Raw Eggs and Dishes with Unpasteurized Ingredients Potential exposure to Salmonella is the biggest concern when it comes to eating raw eggs. While it is easy to not eat raw eggs, it is important to note that some dishes use raw eggs liberally. Homemade ice cream, mayonnaise, salad dressings are usually made with raw eggs. If you are craving for ice cream or a salad with a nice aioli, it is best to buy these items from the grocery store. All commercially manufactured items made from raw eggs use pasteurized eggs to eliminate Salmonella contamination.Caffeine and AlcoholCaffeine intake should be limited to 200 mg a day because this diuretic can result in calcium and water loss. There are websites available that can provide caffeine content for a variety of caffeinated beverages to help you stay within this range.Many patients ask if a glass of wine every once in a while is okay during pregnancy. Unfortunately, I cannot give my blessing to any alcohol consumption while pregnant. There is simply no threshold that has been identified as “safe” and fetal alcohol exposure in the womb at certain developmental stages and levels can have potentially serious consequences on the development of your baby.I hope these guidelines help you approach your food choices during pregnancy with confidence. There are plenty of safe and healthy choices available to nourish both you and your baby. If you have any questions, visit with us at Frisco Women’s Health. For questions or to book an appointment, please contact 972 668 8300. Our friendly personnel would be happy to assist you.