Hygienic Requirements for Pregnant Women to Protect Against Food Infections Part I
Prevention of salmonellosis, toxoplasmosis, and listeriosis in pregnancy
Food infections caused by toxoplasmosis, listeria, and even salmonella are in most cases outside of pregnancy unproblematic or with harmless symptoms that are quickly reversible. In pregnancy, however, such infections can damage the unborn child or, for example, lead to premature births. These infections are also rare during pregnancy, but certain points should be considered to prevent a risk of infection.
The recommended precautionary and hygiene measures should also be observed throughout breastfeeding and later regarding the protection of young children, as these are among the most vulnerable groups.
In everyday life in healthy people with a good immune system, various precautionary measures are of course also recommended, but not the rigid measures of disinfection and avoidance of certain contaminations and certain foods. With e.g. people living on farms automatically have more contaminations with animal excretions and you do not see more frequent infections, but you can even see a "training" of the immune system and less overreacted or misdirected immune reactions, e.g. Allergies.
Various recommendations presented here concern pregnant women in particular!
Guide-Lines
Where caution is required and what measures should be taken? (especially for pregnant women and households with infants and young children; and immunodeficient people)
The rules are:
Shop consciously
Clean and store properly (cooling and protecting against contamination – observe hygiene criteria more strictly)
Preparing (for many things this concerns the adequate heating of foods at contamination risk)
Short-term consumption or other storage (recooling and protecting against contamination)
Summary of infection protection in the context of nutrition
Pregnant women should not consume raw food from animals!
In our cultural areas, this mainly concerns products made from raw milk, or raw meat (e.g. various sausages and little cooked steak, etc.) or raw fish or raw marine animals (sushi and smoked or stained fish products). But some other foods that have a higher possibility of contamination should also be avoided.
The following table summarizes general points concerning the selection and storage as well as preparation of risk-contaminated foods. This is followed by the recommendations with additional details and regarding the various measures.
Overview table on safety or caution regarding foods in pregnancy
The statement here means the risk of infection against salmonella, toxoplasmas or listeria (fundamentally, infections with other germs and other foods are possible)
Dairy products
These foods are safe if they are of good quality - tips for selection, preparation, and storage
For pregnant women, dairy products are only eligible from pasteurized or highly heat-treated milk
Raw milk directly from the farm, which is not heated, must be boiled.
The pasteurized or highly heated dairy products should be consumed in a short time after opening (preferably within 2-3 days).
Pregnant women should choose rather long-ripened hard cheeses made from pasteurized milk (pay attention to ingredients list!) for cheese.
As a precaution, it is better to cut the bark carefully before eating (do not contaminate your food plate or other foods with the bark).
Cheese in one piece is better than cold cuts. Smaller, faster-consumed pieces are an advantage.
If cold cuts are chosen, small amounts should be freshly sliced at the counter.
With ready-packaged cheese cold cuts, it is best to choose only small quantities, and the shelf life date should last even longer. Packed grated cheese is not suitable.
Grated cheese is only okay if you rip it off from a piece without bark right before eating.
Cheese should be stored in the refrigerator* at 5-8°C and consumed within 2-3 days. *(in modern refrigerators at upper compartment)
Pregnant women should not eat these foods or heat them sufficiently high and for a long time (> 70 ° C> 10 min. see above). Toxoplasma, listeria or salmonella sometimes occur here
Pregnant should not consume raw milk and foods made from it. In Germany, such products must be labeled with "raw milk" in the list of ingredients.
If it is raw milk cheese, only very long matured hard cheese can be considered safe.
Also avoid cheese with blue mold (e.g. Gorgonzola)
Avoid cheeses with sticky red-yellow bark (such as Limburger, Tilsiter, basket cheese, hand cheese, Harzer, etc.)
Avoid pre-made grater cheese
Also be careful with cheese or cream cheese from open containers e.g. in buffets, in the refrigerated counter or the gastronomy (e.g. feta, mozzarella, but also curds)
Meat - Meat products and eggs
These foods are safe in good quality - tips for selection, preparation and storage
Meat and fish should always be well cooked through – it should be hot for at least 2 minutes above 70°C (better 80°C core temperature). If there is a salmonella infection risk, it is only safe if total meat (even inside) has been heated to over 70°C for more than 10 minutes. Check the internal temperature with a roast thermometer.
Vegan meat substitutes are a very good alternative and provide valuable phytonutrients. Some of such products can be consumed raw, some are to be heated. Eggs should only be consumed hard-boiled during pregnancy.
If the sausage and other meat products have been heated sufficiently during production, you can also eat them cold, if the cold chain was intact. For example:
Broth sausage or meat sausage such as mortadella, yellow sausage, beer ham, liver cheese, Cervelas-Lyoner
Cooking sausage, such as long cooked mead sausages, cornet beef, blood sausage, aspic, liver sausage (avoid liver products during early pregnancy! See below note)
Cookedcured meat products, such as Kassler meat, turkey breast, cooked ham (however, these are meat products to be considered with caution and you should pay attention to the total nitrate load of your food and local tap water or drinking water);
Preserved sausages in jars or cans are usually made of sufficiently heated meat (it is for other reasons, but not the recommended type of meat – see topic nutrition pyramid)
As with cheese, it is also better for sausages and meat products to buy them as one piece. However, if you choose cold cuts, let small amounts freshly slice at the counter.
With pre-packaged cold cuts, choose only small quantities with long-term minimum durability.
Store the products in the refrigerator at 2-4°C - if opened, for a maximum of 2-3 days.
Raw meat should be stored at 1-0°C only very briefly (in the extra compartment if available, or on the glass patty - at the backside, right above the vegetable compartment of the refrigerator.
Minced meat should be processed on the same day and cooked well.
Note: Finished meat products (sausage, Kassler, liver cheese, etc.) are low in the context of health promotion (see topic Nutrition pyramid newsletter slates 8-9 and 7); and liver products should be avoided in the first three months of pregnancy because of the risk of high vitamin A content - throughout pregnancy, liver should be considered with caution (potentially contains higher amounts of pollutants).
Pregnant women should not eat these foods or heat them sufficiently high and for a long time (> 70 ° C> 10 min. See above). Toxoplasma, listeria or salmonella sometimes occur here
Pregnant women should not eat eggs that are not cooked hard; and no egg products that have not been cooked, fried, or baked enough.
Raw and not enough cooked meats such as tartare, rare or medium-rare steaks, carpaccio, etc. should be avoided
Raw sausages such as salami, mett sausage, tea sausage, cervelat sausage (Cervellata, Safaladi); smoked durable sausages such as cabanossi, etc. should also be avoided.
Also, pregnant women should avoid raw smoked meat-products, such as raw ham (smoked ham), smoked bacon, salmon or nut ham and other
Attention: even roast sausages that have not been fried for long enough can still be of risk.
Fish - Fish products and marine animals
These foods are safe in good quality - tips for selection, preparation and storage
Fish and marine animals are only well fried or soured (preserved in vinegar) possible
Fry fish well, even if it gets drier (help you along with appropriate sauces); Cooking or poaching for a longer time in the brew for about 10-15 minutes also helps and leaves the fish juicier.
Heat shrimp and crustaceans in the same way, even if they are already pre-cooked.
Canned fish is OK; they should be kept open for a maximum of one day in the refrigerator.
Fish in original sealed jars soured (preserved) you can use if the fish was completely covered by the vinegar liquid (e.g. Bismarck herrings, rollmops). Store these products in the refrigerator at 5-8°C, use them long before the minimum shelf life, and consume them within 2-3 days after opening.
Other ready-to-eat fish products, such as the meat products, can be stored in the refrigerator at 2-4°C – open for a maximum of 1-2 days.
Raw fish meat should only be stored at 1-0°C for a maximum of one day (in an extra compartment if available, or on the glass patty - at the very back - above the vegetable compartment).
Fish minced meat (fish meat) should be processed and cooked well on the same day.
Pregnant women should not eat these foods. Toxoplasma, listeria or salmonella sometimes occur here
Pregnant women should not eat food with raw fish or raw marine animals: such as sushi, sashimi, fish carpaccio, oysters, raw crabs
Should not eat smoked or stained fish products, such as marinated salmon, smoked salmon, and other smoked fish, and smoked marine animals (crabs, etc.)
Should not eat all processed fish products that need to be refrigerated*, such as sour cream herring, matjes rolls, *with the exception of sour pickled fish (roll mops are possible with correct bottling - see above)
Appetizers - Antipasti
These foods are safe in good quality - tips for selection, preparation and storage
Antipasti, creams, and dressings, which have been heated and can be preserved without refrigeration, such as olives, prepared vegetables, vegetables, and pods are OK
Such products (including those from the refrigerated shelf) should best be consumed long before the minimum shelf date; store them in the refrigerator at approx. 5-8°C; open within 2-3 days
Salads in general and salads of rice, potato, or pasta are best prepared immediately before eating.
Industrially produced mayonnaise is highly heated usable, but better are other homemade fresh dressings made from oil and vinegar.
Always use fresh ingredients and prepare everything just before consumption.
Pregnant women should not eat these foods. Here sometimes come toxoplasmas, listeria, salmonella before
Finger food, salads and antipasti from open containers in restaurants, canteens, and buffets are unsuitable for pregnant women
Meat- and fish-pastries are also unsuitable for pregnant women
Appetizers with matjes (kind of herring), smoked fish, seafood, but also feta cheese pregnant women should avoid.
Vegetables - Leaf salads - Herbs - Fruit
These foods are safe in good quality - tips for selection, preparation and storage
Vegetables and fruits, as well as herbs that are frozen or fresh, (such as from your own garden or breeding pot or in good quality from the market) and without mold or contamination with animal excretions are safe if they are thoroughly washed or hand watering after purchase and shortly before raw consumption* again.
*(raw consumption is recommended for fruit and herbs as well as some vegetables with regard to the better bioavailability of protective substances such as micronutrients – especially secondary plant substances).
Vegetables are very good if it is washed well beforehand and cooked just before eating, - stew soup is a good choice
Vegetables, as well as fruits and herbs, are possible as raw foods if there is no contamination with animal excretions (better wash for raw consumption twice)
Fresh kitchen herbs, such as basil and parsley, are a good choice if they come from your own garden or plant pot and have no contamination of animal excretions and no mold.
Fruits and herbs should be consumed raw because of their heat-sensitive micronutrients; also frozen they are good to use.
Industrially produced smoothies and juices packaged under a protective atmosphere, as well as canned fruit vegetables are safe. But freshly prepared and drunk immediately they are of advantage for other reasons.
The ingredients from home-made smoothies and juices should be well washed and fresh.
The raw food should be consumed within 2 hours or stored in the refrigerator (fruit vegetable compartment 8-10°C) for soon consumption. Freshly produced fruit juices and smoothies should be stored cooler in the refrigerator at a maximum of 4°C (in the middle compartment) and be consumed within a day
Pregnant women should not eat these foods. Toxoplasma, listeria or salmonella sometimes occur here
Herbs and sprouts or seedlings, which are more likely to have mold infestation or contamination with germs, are rather unsuitable for pregnant women. Seedlings and sprouts are otherwise very healthy, but during pregnancy from the market rather not suitable because of the risk of contamination (grown from own seeds are possible if mold and contamination are prevented).
Unwashed fruits, vegetables, herbs, and leaf salads should not be consumed
Pre-packaged salads, such as pre-made cut and mixed salads, or vacuum-packed products* are also rather unsuitable – even some coleslaw, which stored in an acidic environment, are less suitable (better always prepare yourself freshly) – *vacuum-packed can even reproduce listeria in case of contamination
Pre-cut fruit, such as melons or fruit salads from the market, gastronomy, buffets or canteens are more likely to be avoided (they need a very good cold chain, which is often not guaranteed)
Freshly squeezed fruit and vegetable juices in the gastronomy, at juice sale counters or at buffets, or even juice presses in such facilities, where everyone can squeeze themselves, are rather unsuitable for pregnant women.
Cereal products and baked goods
This Food is safe in good quality - tips for selection, preparation and storage
Bread, pastries (cakes, pastries, and biscuits), as well as cereals and cereal flakes are good to use
In the case of cakes, care must be taken to ensure that it has been completely baked
In the case of baked goods with cream, mousse or pudding, but also with fruit, should only be consumed if they have been freshly prepared and are consumed immediately - or stored adequately at approx. 4°C cooled - and then consumed within a day (maximum 2 days)
Sandwiches should only be prepared from fresh ingredients and consumed within 2 hours or kept in the refrigerator at 0-2°C (bottom compartment on the glass plate) for a maximum of 4-6 hours. It is best not to use mayonnaise or other spreads for such slices of breads, which are fast-breeding grounds for germs.
Pregnant women should not eat these foods. Toxoplasma, listeria or salmonella sometimes occur here
Prefabricated sandwiches in retail stores, or at buffets or canteens, etc. are unsuitable
Cake and other sweet pastries with unbaked fillings or dressings (such as creams, mousse or chocolate cream or honey spread, or fruit with gelatin) from bakeries or other sales counters are unsuitable
Desserts such as tiramisu are rather unsuitable during pregnancy
General information
Select carefully good quality food (concerning impeccable goods, no mold, intact packaging; labeling of the content and minimum durability); transport quickly, and if necessary, already cool (cooling box or cooler bag preferably also with cooling ice packs) and then store as fast as possible cool (often necessary in the refrigerator) - keep the cold chain management
If necessary, buy frozen food separately (not at long-lasting large-scale shopping), or get it out of the refrigerated shelf at the end and transport it immediately in the refrigerated box or cooler bag (each with refrigerated cooling packs); or get it in your house by delivery service with refrigerated vehicles.
The minimum shelf life of food should be considered more strictly in the context of pregnancy, i.e. the expiry date should be long ahead of time.
The best-before date (minimum shelf life) in Germany, for example, is 28 days for eggs and is indicated on the carton for packaged eggs. Selling must take place latest by the 21st day (so, not later than seven days before the end of the minimum shelf life). However, it is best to buy eggs that are still durable for at least 3 weeks, store them in the refrigerator and use them soon.
Foods that are easily perishable and have a higher risk of infection should be consumed within 1-2 days after purchase.
Always use clean tap water according to the quality standards, as is common in German, for washing, cooking and rinsing – at home and also when you are traveling.
If necessary, use additional filtered* tap water (concerning nitrates, hormones, etc.) or natural spring water (mineral water from controlled natural sources) bottled in glass bottles. Normal table filters are not suitable for this and are often a stove for germ contamination.
Prof. Dr. Werner Seebauer is Dean of Studies – Association of German Preventologists, Head of Preventive Medicine Department of Institute of Transcultural Health Sciences (European University Viadrina) and Head of Preventive Medicine – NESA (The New European Surgical Academy). Since 2000, prof. dr. Werner Seebauer worked only in preventive medicine, after ten years spent at the Frankfurt University Hospital. He is also involved in the medical professionals training for nutrition and prevention.