Most sushi is off-limits during pregnancy, but you don’t have to skip the sushi restaurant entirely. The core issue is raw fish: health agencies recommend pregnant women avoid raw or undercooked seafood because of the elevated risk of bacterial and parasitic infections. Cooked sushi rolls, vegetable rolls, and many other menu items are perfectly fine and can actually be a great way to get nutrients you and your baby need.
Why Raw Fish Is Risky During Pregnancy
Raw seafood is more likely to harbor bacteria and parasites than cooked fish. The biggest concern is Listeria monocytogenes, a bacterium that causes an infection called listeriosis. In most healthy adults, listeriosis causes mild flu-like symptoms or no symptoms at all. During pregnancy, the stakes are dramatically different.
Pregnant women are about 20 times more likely to develop listeriosis than the general population, and they account for roughly 27% of all cases. The infection can lead to miscarriage, stillbirth, premature delivery, or serious health problems for the newborn, including meningitis and blood infections. The incidence in pregnancy is about 12 per 100,000, so it’s still rare in absolute terms, but the consequences are severe enough that avoiding raw fish is a straightforward way to reduce your risk.
Beyond Listeria, raw fish can carry parasites like Anisakis. Commercial sushi-grade fish in the U.S. is typically flash-frozen to kill parasites (held at -4°F for seven days, or blast-frozen at -31°F and stored for at least 15 to 24 hours). That process is effective against parasites but does not eliminate bacteria like Listeria. Cooking fish to an internal temperature of 145°F kills both.
Cooked Sushi You Can Safely Eat
A sushi restaurant menu has far more cooked options than most people realize. These are all considered safe during pregnancy:
- Cooked shrimp rolls (like shrimp tempura rolls)
- Cooked salmon rolls
- California rolls (made with imitation crab, which is cooked)
- Tempura rolls (battered and fried)
- Eel rolls (unagi is always served cooked)
- Cucumber or avocado rolls
- Edamame, miso soup, and seaweed salad
Cooked shrimp and salmon are especially good choices because they’re high in protein and omega-3 fatty acids, which directly support your baby’s brain development. If you’re choosing cooked fish, stick to lower-mercury options like salmon, shrimp, and crab rather than higher-mercury fish like swordfish or bigeye tuna.
Watch for Cross-Contamination
Even if you order a vegetable or cooked roll, there’s a practical concern: most sushi restaurants prepare raw and cooked items on the same surfaces with the same tools. If a veggie roll is prepped on the same cutting board where raw fish was just sliced, you could be exposed to the bacteria you’re trying to avoid. Choose a reputable restaurant that follows food safety standards, and don’t hesitate to ask the chef whether they use separate prep areas for cooked and raw items.
Why Fish Still Matters During Pregnancy
The goal isn’t to avoid fish altogether. The FDA recommends that pregnant women eat 8 to 12 ounces of low-mercury fish per week because the nutritional benefits are significant. Omega-3 fatty acids, particularly DHA, are critical building blocks of your baby’s developing brain and eyes. These are essential fats your body can’t produce on its own.
Research consistently links higher fish consumption during pregnancy to better developmental outcomes. One study found that mothers who ate more fish during pregnancy had children with higher scores on visual recognition memory and verbal intelligence tests. Animal studies have shown that omega-3 deprivation during pregnancy leads to visual and behavioral deficits that can’t be corrected after birth. In short, eating cooked fish regularly during pregnancy is not just safe, it’s actively beneficial.
Mercury Levels by Fish Type
Not all fish carry the same mercury load. The FDA divides fish into three categories for pregnant women:
Best choices (2 to 3 servings per week): salmon, shrimp, tilapia, cod, catfish, sardines, anchovies, trout, pollock, crab, scallops, squid, and herring, among others. These have the lowest mercury levels and are the safest to eat regularly.
Good choices (1 serving per week): albacore (white) tuna, yellowfin tuna, halibut, mahi mahi, snapper, and grouper. Albacore tuna contains about three times more mercury than canned light tuna, so if you eat it, limit yourself to one serving that week and skip other fish from this category.
Fish to avoid entirely: king mackerel, marlin, orange roughy, shark, swordfish, tilefish from the Gulf of Mexico, and bigeye tuna. These have the highest mercury concentrations.
One serving is about 4 ounces, roughly the size of your palm. Canned light tuna (typically skipjack) falls in the “best choices” category, so you can eat 2 to 3 servings per week without concern. If you prefer albacore, keep it to 1 serving per week with no other “good choice” fish that same week.
What to Skip Beyond Sushi
The raw fish rule extends beyond the sushi bar. Raw oysters, clams, mussels, scallops, ceviche, poke bowls with raw fish, and lox or cold-smoked salmon all carry the same risks. If the seafood hasn’t been cooked to a safe temperature, treat it the same way you’d treat a raw tuna roll. Fully cooked versions of all of these are fine.