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Can Fam Physician. 2010 August; 56(8): 750–751.
PMCID: PMC2920771

Food safety during pregnancy

Marsha Taylor and Eleni Galanis, MD MPH CCFP FRCPC

While we were happy to see the issue of food safety during pregnancy addressed in the April 2010 Motherisk Update,1 we were also concerned about some of the information in the article contradicting public health messages on this topic.

The authors state there is increased incidence of disease or severe outcomes for the woman or neonate. However, they also recommend that foods that might contain Listeria monocytogenes (eg, deli meats, soft cheeses), Salmonella (eg, eggs), or various bacteria, viruses, and parasites (eg, raw fish) are safe for consumption if properly handled and stored and purchased from reputable suppliers. These statements appear to contradict each other and are not supported by the literature and public health recommendations.25

The authors do not provide references for many of their statements or else, in certain instances, use references that are out of date or not representative of Canada. Nonpublished literature (eg, government documents, guidelines) and content experts have not been consulted to identify recent Canadian outbreaks, public health programs, and messages related to this topic.

The authors suggest that improved standards and surveillance have reduced the prevalence of contaminated foods in grocery stores and that the frequency of outbreaks has decreased. It is not possible to say whether the prevalence of contaminated foods and frequency of outbreaks have decreased. Some literature suggests that the number of outbreaks and the incidence of Salmonella and Listeria are increasing.6,7 Outbreaks and food recalls8 related to listeriosis and deli meats9,10 or soft cheeses,11,12 as well as salmonellosis and eggs,7,13 continue to occur.

Food stored in a refrigerator allows the growth of Listeria, which prefers to multiply at these temperatures.14 Proper storage therefore increases the risk of listeriosis. Proper handling of food (eg, washing hands) is recommended; however, foods such as deli meats and cheeses might already be contaminated when purchased. The consumer does not typically take additional steps at home (eg, cooking) to reduce potential pathogens in such foods. Although purchasing food from a reputable supplier with approved food safety plans is a good suggestion, even reputable suppliers can have problems on account of the ubiquitous nature of these pathogens in a food processing environment.9,10 Additionally, it is not possible for a pregnant woman to identify foods that have been prepared or stored appropriately in restaurants and outside of the home (eg, flash-frozen sushi, refrigerated eggs).

Finally, the authors have made some unfounded recommendations. The Public Health Agency of Canada and most provincial, territorial, and local public health authorities in Canada as well as in many other countries recommend the following3,4,15,16:

  • Pregnant women should avoid consuming unpasteurized milk and dairy products, soft cheeses (both pasteurized and unpasteurized), deli meats, and smoked fish owing to the potential risk of listeriosis. Such foods can only be safely eaten if heated to 74°C (165°F).
  • Pregnant women and the general population should avoid consuming raw and undercooked eggs. They should store eggs in the refrigerator and wash their hands as well as any utensils or surfaces after contact with raw eggs. The use of pasteurized egg products is recommended when a recipe calls for raw eggs.
  • Pregnant women and the general population should be aware that consuming raw fish, shellfish, or raw bivalves (eg, oysters) increases the risk of Vibrio, noro-virus, and other food-borne infections.

Research has shown that health care providers might not provide sufficient information about risks associated with food safety to pregnant women and that messages should be improved and targeted.2,1719 There is ongoing work in Canada to address this.

Motherisk is a valuable and credible source of information for pregnant women and their health care providers. However, as evidenced by this article1 and another published2 in the same issue of Canadian Family Physician, further work is needed to improve food safety knowledge among pregnant women and their health care providers.

References

1. Tam C, Erebara A, Einarson A. Food-borne illnesses during pregnancy. Can Fam Physician. 2010;56:341–3. [PMC free article] [PubMed]
2. Kirkham C, Berkowitz J. Listeriosis in pregnancy. Survey of British Columbia practitioners’ knowledge of risk factors, counseling practices, and learning needs. Can Fam Physician. 2010;56:e158–66. [PMC free article] [PubMed]
3. Public Health Agency of Canada [website] Listeria—protecting your pregnancy. Ottawa, ON: Public Health Agency of Canada; 2008. Available from: www.phac-aspc.gc.ca/alert-alerte/listeria/pp-pg-eng.php. Accessed 2010 Jul 6.
4. Centers for Disease Control and Prevention . Listeriosis (Listeria) and pregnancy. Atlanta, GA: Centers for Disease Control and Prevention; 2010. Available from: www.cdc.gov/ncbddd/pregnancy_gateway/infections-listeria.html. Accessed 2010 Jul 6.
5. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: part 1. General prenatal care and counseling issues. Am Fam Physician. 2005;71(7):1307–16. [PubMed]
6. Lynch M, Painter J, Woodruff R, Braden C, Centers for Disease Control and Prevention Surveillance for foodborne disease outbreaks—United States, 1998–2002. MMWR Surveill Summ. 2006;55(10):1–42. [PubMed]
7. British Columbia Centre for Disease Control . 2008 British Columbia annual summary of reportable diseases. Vancouver, BC: British Columbia Centre for Disease Control; 2009. Available from: www.bccdc.ca/NR/rdonlyres/59BFCFBB-933D-4337-9305-E3E5FF30D272/0/EPI_Report_CDAnnual2008_20091202.pdf. Accessed 2010 Jul 6.
8. Canadian Food Inspection Agency [website] Food recall alerts—high-risk. Ottawa, ON: Canadian Food Inspection Agency; 2010. Available from: www.inspection.gc.ca/english/corpaffr/recarapp/recaltoce.shtml. Accessed 2010 Jul 6.
9. Attaran A, MacDonald N, Stanbrook MB, Sibbald B, Flegel K, Kale R, et al. Listeriosis is the least of it. CMAJ. 2008;179(8):739–40. 743–4. Epub 2008 Sep 16. [PMC free article] [PubMed]
10. Government of Canada [website] Report of the independent investigator into the 2008 listeriosis outbreak. Ottawa, ON: Government of Canada; 2009. Available from: http://news.gc.ca/web/article-eng.do?m=/index&nid=468909. Accessed 2010 Jul 6.
11. Gaulin C, Ramsay D, Ringuette L, Ismaïl J. First documented outbreak of Listeria monocytogenes in Quebec, 2002. Can Commun Dis Rep. 2003;29(21):181–6. [PubMed]
12. Clark CG, Farber J, Pagotto F, Ciampa N, Doré K, Nadon C, et al. Surveillance for Listeria monocytogenes and listeriosis, 1995–2004. Epidemiol Infect. 2010;138(4):559–72. Epub 2009 Oct 12. [PubMed]
13. Braden CR. Salmonella enterica serotype Enteritidis and eggs: a national epidemic in the United States. Clin Infect Dis. 2006;43(4):512–7. Epub 2006 Jul 3. [PubMed]
14. Rocourt J, Cossart P. Listeria monocytogenes. In: Doyle MP, Beuchart LR, editors. Food microbiology. Fundamentals and frontiers. Washington, DC: ASM Press; 1997. pp. 337–52.
15. Health Canada [website] Listeria and food safety. Ottawa, ON: Health Canada; 2010. Available from: www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/listeria-eng.php. Accessed 2010 Jul 6.
16. Canadian Food Inspection Agency . Food safety facts on Listeria. Ottawa, ON: Canadian Food Inspection Agency; 2010. Available from: www.inspection.gc.ca/english/fssa/concen/cause/listeriae.shtml. Accessed 2010 Jul 6.
17. Bondarianzadeh D, Yeatman H, Condon-Paoloni D. Listeria education in pregnancy: lost opportunity for health professionals. Aust N Z J Public Health. 2007;31(5):468–74. [PubMed]
18. Cates SC, Carter-Young HL, Conley S, O’Brien B. Pregnant women and Listeriosis: preferred educational messages and delivery mechanisms. J Nutr Educ Behav. 2004;36(3):121–7. [PubMed]
19. Morales S, Kendall PA, Medeiros LC, Hillers V, Schroeder M. Health care providers’ attitudes toward current food safety recommendations for pregnant women. Appl Nurs Res. 2004;17(3):178–86. [PubMed]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada