Early pregnancy is when your baby’s major organs, brain, and spinal cord are forming, which makes the first trimester the most sensitive window for avoiding things that could disrupt development. The list of what to skip covers food, drinks, medications, skincare products, and some everyday household items. Here’s what matters most and why.
Foods That Carry Infection Risk
Your immune system dials down during pregnancy to protect the baby, which makes you more vulnerable to foodborne infections. Two bacteria in particular, Listeria and Toxoplasma, can cross the placenta and cause serious harm even when they only give you mild symptoms.
The FDA flags these as the highest-risk foods for Listeria contamination:
- Deli meats, hot dogs, and luncheon meats unless reheated until steaming hot
- Unpasteurized milk and any foods made with it
- Soft cheeses like queso fresco, queso blanco, and requesón, even when made from pasteurized milk
- Refrigerated pâtés and meat spreads
Raw or undercooked sprouts (alfalfa, clover, mung bean, radish) are another concern. They’re a common source of Salmonella and E. coli, and the FDA recommends cooking them thoroughly rather than eating them raw in salads or sandwiches. Raw or undercooked eggs, meat, and fish carry similar risks. Sushi made with raw fish, runny eggs, and rare steak are all worth skipping until after delivery.
High-Mercury Fish
Fish is generally healthy during pregnancy because of its omega-3 content, but a handful of species accumulate enough mercury to damage a developing nervous system. The FDA lists these as the fish to avoid entirely:
- King mackerel
- Marlin
- Orange roughy
- Shark
- Swordfish
- Tilefish (Gulf of Mexico)
- Bigeye tuna
Lower-mercury options like salmon, shrimp, tilapia, and canned light tuna are safe in moderate amounts, generally two to three servings per week.
Alcohol and Caffeine
The CDC is clear on this: there is no known safe amount of alcohol at any point during pregnancy. Alcohol exposure in the first three months specifically can cause abnormal facial features associated with fetal alcohol spectrum disorders. Brain and nervous system damage can occur from exposure at any point, including before many people realize they’re pregnant.
Caffeine is a different story. The American College of Obstetricians and Gynecologists considers moderate intake, under 200 mg per day, unlikely to contribute to miscarriage or preterm birth. That’s roughly one 12-ounce cup of brewed coffee. Keep in mind that caffeine also shows up in tea, chocolate, energy drinks, and some sodas, so the total adds up faster than you might expect.
Pain Relievers and Other Medications
Ibuprofen, naproxen, and other anti-inflammatory pain relievers (NSAIDs) are widely used, but they pose real risks in early pregnancy. A large meta-analysis covering 38 studies found that NSAID use during early pregnancy was linked to a 28% increased risk of congenital anomalies overall and a 19% increase in major birth defects. Ibuprofen specifically was associated with a higher risk of heart defects. Acetaminophen (Tylenol) is generally considered the safer alternative for pain and fever, though you should still use it only when needed.
Beyond pain relievers, many prescription and over-the-counter medications aren’t tested in pregnant people. If you take anything regularly, including acne treatments, antidepressants, or allergy medications, it’s worth reviewing your full list with a provider as early as possible.
Retinoids in Skincare
Retinoids are vitamin A derivatives found in many anti-aging and acne products. Oral retinoids like isotretinoin are known to cause severe birth defects and are strictly off-limits. Topical retinoids (retinol creams, adapalene gels, tretinoin) absorb far less into the bloodstream, and the European Medicines Agency notes that systemic absorption from topical use is negligible. Still, they remain contraindicated during pregnancy as a precaution because of the severity of the potential harm.
Check the labels of your serums, moisturizers, and acne treatments for retinol, retinal, retinaldehyde, adapalene, tretinoin, or tazarotene. Pregnancy-safe alternatives for acne and skin concerns include azelaic acid and glycolic acid.
Excess Vitamin A
While retinoids get the attention, plain vitamin A in supplement form (retinol) carries similar risks at high doses. Too much can cause malformations including spina bifida, cleft palate, heart defects, and limb deformities. The European Food Safety Authority sets the upper limit at 3,000 micrograms per day for women of childbearing age, and UK guidelines recommend staying below 1,500 micrograms. Most prenatal vitamins use beta-carotene instead of retinol, which your body converts only as needed, making it much safer. Liver and liver products like pâté are extremely high in retinol, which is another reason to avoid them beyond the Listeria risk.
Hot Tubs and Overheating
The neural tube, which becomes your baby’s brain and spinal cord, closes between 17 and 28 days after fertilization. That’s often before you’ve even confirmed the pregnancy. Elevated body temperature during this window is linked to neural tube defects. Research on extreme heat exposure found that even a few consecutive days of high ambient temperatures during the periconception period increased neural tube defect risk by 9% to 29%, depending on duration. Hot tubs, saunas, and prolonged high fevers have all been associated with similar effects.
The concern isn’t a warm bath. It’s sustained heat that raises your core temperature above normal for an extended period. If you use a hot tub, limit sessions to 10 minutes or less and keep the temperature below 101°F. Saunas are best avoided altogether in the first trimester.
Cat Litter and Garden Soil
Toxoplasmosis is caused by a parasite shed in cat feces. Cats pick it up from hunting small animals or eating raw meat, and the parasite ends up in their litter box and any outdoor soil they’ve used. You can become infected by accidentally touching contaminated material and then touching your mouth, which is easier to do than it sounds when you’re gardening or cleaning.
The parasite doesn’t become infectious until one to five days after it’s shed, so daily litter box changes reduce risk. But ideally, have someone else handle litter duty entirely. If that’s not an option, wear disposable gloves and wash your hands thoroughly afterward. The same applies to gardening: wear gloves, wash up when you’re done, and cover outdoor sandboxes so neighborhood cats can’t use them. Keep your cat indoors and feed it commercial food rather than raw meat. This isn’t the time to adopt a new cat, especially a stray or kitten.
Household Chemicals and Fragrances
Phthalates are chemicals used to make plastics flexible and to stabilize fragrances. Research from Harvard’s T.H. Chan School of Public Health has linked phthalate exposure to increased risk of pregnancy loss and gestational diabetes. They’re found in vinyl shower curtains, plastic window blinds, PVC flooring, and any personal care product listing “fragrance” or “parfum” as an ingredient.
You can’t eliminate phthalate exposure entirely, but a few swaps make a meaningful difference. Choose products labeled “fragrance-free” or “phthalate-free” for lotions, shampoos, and sprays. Reduce processed and packaged food, which can pick up phthalates from packaging materials. If you’re replacing household items anyway, opt for non-PVC shower curtains, bamboo or cotton blinds, and natural linoleum instead of vinyl flooring. These changes don’t need to happen overnight, but they’re worth making where it’s practical.
Smoking and Secondhand Smoke
Smoking during pregnancy restricts oxygen and nutrient delivery to the baby and is linked to miscarriage, placental problems, preterm birth, and low birth weight. Secondhand smoke carries many of the same risks. If you smoke, early pregnancy is the most impactful time to quit, since the first trimester is when foundational development happens fastest. Vaping and e-cigarettes still deliver nicotine, which affects fetal brain development, so they’re not a safe substitute.