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    Be aware of what foods to avoid during pregnancy

    Which foods are real threats during pregnancy? Your patients are anxious for answers and welcome your practical advice about coffee, alcohol, mercury, and more.


    The good news for all Americans—and pregnant women in particular—is that the United States has one of the world's safest food supplies; in fact, the rates of many food-borne illnesses have dropped since 1996.1 That said, the food system continues to face new challenges, including the high turnover of food industry workers and the possibility of someone intentionally contaminating the food supply.2

    Nowadays, your pregnant patients eat a wider variety of foods, including more imported products and foods prepared outside the home.2 Food imports are up by 35%, to 48 million metric tons, over the past decade.3 Although imports now comprise roughly 15% of the US diet, the percentages of imports in some food categories are much higher. In 2005, 54% of tree nuts and 84% of fish and seafood eaten were imported.3

    The safety of imported foods has raised concerns, especially because more of the inherently high-risk foods (ready-to-eat food, fresh produce, and seafood) are imported.1 However, by recent estimates, the US Department of Agriculture (USDA) physically examines only 10% of imported meat and poultry, and 4% of the imports get microbial testing.3 The FDA (responsible for most other food and drink) estimates it physically examines or tests only 1% of food imports.3

    Home-grown headaches

    We're far from home free on domestically produced foods. Although the USDA must be present in meat and poultry processing plants for at least part of each day, the FDA inspects "high-risk" facilities once per year; others are inspected only every 5 to 10 years.3 Despite concern that imported food may pose more risks,4 this hasn't been determined,2 and some imported foods have been found to be less contaminated than domestically produced foods.5,6


    Fish guidelines for pregnant patients
    Pregnancy is one "window of susceptibility" during which the risk of environmental contamination may be higher.7 Exposure to toxins during pregnancy can affect the developing fetus far more than it would an adult, depending on how easily the toxin crosses the placenta, whether the toxin con-centrates in the fetus, and whether the toxin affects metabolically active tissues.

    Our goal is to address the risk to the expectant woman and her baby of toxin exposure in commonly ingested foods. (Part 1 of this series in the November 2009 issue addressed the general food safety concerns of listeriosis, toxoplasmosis, raw fish, sprouts, eggs, peanuts, and cultural differences.) This article contains additional informational sources and Web sites for both Parts 1 and 2. Please see the section "Food safety Web resources" and online at http://www.contemporaryobgyn.net/oktoeat.


    Sharon T. Phelan, MD
    Dr. Phelan is a Professor in the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque.

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