Fish is one of the most nutritious foods you can eat while pregnant. It’s packed with protein, healthy fats (including DHA for your baby’s brain development), and other essential nutrients.

But guidance can be confusing: What’s safe? What’s not? This comprehensive guide brings together evidence-based recommendations from the FDA, USDA, CDC, and ACOG, so you have all the information you need in one place.

How much fish should you eat?

The FDA recommends 2–3 servings (8–12 ounces) of low-mercury fish per week.

What does that look like?

Think of 1 serving = the size of your palm (about 4 ounces).
A typical can of tuna = 5 ounces.
A fillet of salmon at a restaurant = usually 6–8 ounces.

What to avoid:

Raw fish sushi (tuna, salmon, yellowtail, eel), raw fish poke bowls, ceviche, crudo (see below for more context), raw oysters, clams, mussels, refrigerated smoked seafood (lox, nova, kippered fish, smoked trout), high-mercury fish (shark, swordfish, king mackerel, tilefish from the Gulf of Mexico, bigeye tuna, marlin, orange roughy), jerky-style fish products.

What’s safe:

Sushi made with cooked seafood (shrimp tempura rolls, cooked crab rolls), vegetable sushi rolls (avocado, cucumber), fully cooked shellfish (shrimp, scallops, clams, mussels, crab), shelf-stable smoked seafood, smoked fish that has been reheated until steaming hot.

Best fish choices (low mercury):

Salmon, shrimp, pollock, tilapia, cod, catfish, sardines, anchovies, herring, trout, canned light tuna (limit albacore/white tuna to 4 ounces per week).

Sushi and Raw Fish: Understanding the Risk Spectrum

Raw fish can carry harmful bacteria and parasites, including Listeria and Salmonella, which are especially risky during pregnancy. However, the actual risk level is more nuanced than blanket avoidance recommendations suggest.

The Conservative Approach

Traditional pregnancy guidance recommends avoiding all raw fish because:

• Any risk feels too high when it comes to pregnancy complications
• Freezing doesn’t eliminate all pathogens – while it kills parasites, it doesn’t eliminate bacteria like Listeria, Salmonella, and Vibrio
• Pregnancy increases vulnerability to foodborne illness
• Consequences can be severe – while rare, listeria infections during pregnancy can cause miscarriage, stillbirth, or serious newborn complications

The Risk-in-Context Perspective

Some nutrition experts argue the absolute risk is much lower than commonly perceived:

Regarding parasites: The FDA requires nearly all fish served raw in the US to be frozen first at specific temperatures (-4°F/-20°C for 7 days, or -31°F/-35°C for 15 hours), which effectively kills parasites. This is why parasite infections from sushi are extremely rare in the US.

Regarding bacteria: While freezing doesn’t eliminate all bacteria, high-quality sushi restaurants follow strict handling protocols, use sushi-grade fish from reputable suppliers, and have rapid turnover that minimizes bacterial growth.

Putting risk in perspective: Food recalls in recent years have affected many foods we don’t restrict during pregnancy – including leafy greens, cantaloupe, and ice cream. We don’t avoid driving during pregnancy despite car accidents being a leading cause of injury, because we weigh risks against benefits and take reasonable precautions.

Making Your Own Decision

Consider these questions:

• How will you feel if you eat raw fish? If you’ll spend the next few days worried, the stress probably isn’t worth it
• What’s your risk tolerance? Some people are comfortable with small, well-calculated risks; others prefer maximum caution during pregnancy
• Where are you eating? A high-end sushi restaurant with excellent reputation and rapid turnover presents different risks than questionable sources
• What type of fish? Some fish (like farmed salmon) may have lower pathogen risks than others

If You Choose to Eat Raw Fish:

• Choose reputable establishments with high turnover and excellent food safety practices
• Avoid fish that’s been sitting out or looks less than fresh
• Start with small amounts if you haven’t eaten raw fish recently
• Trust your instincts – if something looks, smells, or tastes off, don’t eat it
• Consider your overall health – if you have any immune system concerns, err on the side of caution

Safer Sushi Options:

• Cooked options: Shrimp tempura rolls, cooked crab rolls, eel (which is cooked), cooked salmon rolls, cooked tuna rolls
• Vegetarian rolls: Avocado, cucumber, pickled vegetables
• Smoked fish that’s been heated until steaming hot

Bottom line: This is a personal decision. The absolute risk is low but not zero. If you choose to avoid raw fish entirely, you’re following well-established safety guidelines. If you choose to occasionally eat high-quality sushi from reputable sources, understand you’re taking a risk that many experts consider manageable.

High-Mercury Fish

Mercury is a heavy metal that can affect your baby’s developing brain and nervous system. Certain fish contain higher levels of mercury and should be avoided completely during pregnancy.

Avoid shark, swordfish, king mackerel, tilefish from the Gulf of Mexico, bigeye tuna, marlin, and orange roughy.

Raw Shellfish

Raw shellfish—such as oysters, clams, and mussels—are not safe in pregnancy due to the risk of bacteria and viruses like Vibrio and norovirus.

Only eat shellfish that has been thoroughly cooked.

Smoked Seafood

Refrigerated smoked seafood (like lox, nova, kippered fish, and smoked trout) can carry Listeria, even when properly refrigerated.

Avoid refrigerated smoked fish unless it’s been cooked into a dish, like a casserole.
Safer options include shelf-stable smoked seafood and smoked seafood that has been reheated until steaming hot.

Storing Seafood Safely During Pregnancy

Safe storage is essential to reduce the risk of foodborne illness from seafood during pregnancy. Follow these guidelines:

• Refrigerate seafood immediately after purchase at 40°F (4°C) or below.
• Use fresh seafood within 1–2 days of purchasing.
• Store seafood in the coldest part of your fridge, ideally in a shallow container covered with ice or in its original packaging.
• Freeze seafood at 0°F (-18°C) if you don’t plan to eat it within a couple of days.
• Thaw frozen seafood safely in the refrigerator overnight, never on the counter.
• Discard seafood that smells sour, overly fishy, or like ammonia.
• Once cooked, store seafood leftovers in the fridge and eat them within 3–4 days.

Your Pregnancy Fish Safety Checklist

• Eat 2–3 servings of low-mercury fish weekly.
• Avoid high-mercury fish, raw fish, raw shellfish, and cold smoked seafood.
• Choose cooked seafood and vegetables in sushi.
• Make sure all fish and shellfish are fully cooked.
• Store seafood properly and eat it fresh.
• Follow good kitchen hygiene when handling seafood.

Bottom line:

Fish is an important part of a healthy pregnancy diet. By avoiding raw and high-mercury fish and choosing fully cooked, low-mercury options, you can safely enjoy the benefits of fish while protecting your baby.

Sources

U.S. Food and Drug Administration (FDA). Eating Fish: What Pregnant Women and Parents Should Know. https://www.fda.gov/food/consumers/advice-about-eating-fish

Centers for Disease Control and Prevention (CDC). Listeria Prevention. https://www.cdc.gov/listeria/prevention.html

United States Department of Agriculture (USDA). Safe Minimum Internal Temperature Chart. https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/safe-temperature-chart

American College of Obstetricians and Gynecologists (ACOG). Nutrition During Pregnancy. https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy

U.S. Department of Health and Human Services (HHS). Keep Food Safe! Food Safety Basics. https://www.foodsafety.gov/keep-food-safe