Poke bowls traditionally feature diced, marinated raw fish, often tuna or salmon, served over rice and topped with various ingredients. When pregnant, the safety of consuming this dish depends entirely on the preparation of the protein. The main concerns involve two distinct risks: pathogens and parasites in uncooked seafood, and the accumulation of heavy metals like mercury in certain fish species.
Understanding the Risk: Pathogens and Parasites
The primary biological risk of eating raw fish is exposure to harmful bacteria and parasites. Pregnant individuals face a higher risk of foodborne illnesses because the immune system is altered during gestation. This increased susceptibility means that while a non-pregnant person might experience mild symptoms, the outcome for the developing fetus can be severe.
One major concern is the bacterium Listeria monocytogenes, which causes listeriosis. Pregnant women are approximately ten times more likely to contract listeriosis than the general population. An infection with Listeria can lead to serious complications, including miscarriage, stillbirth, premature delivery, and severe health problems for the newborn.
Raw seafood also carries the potential for parasites, such as Anisakis worms, and bacteria like Salmonella. Although commercial freezing processes for “sushi-grade” fish kill parasites, this process does not eliminate the risk of Listeria. Listeria can survive and even grow in refrigerated temperatures, leading health authorities to advise pregnant women to avoid all raw seafood, including poke, sushi, and ceviche.
Considering Fish Type: Mercury Concerns
Separate from the risk of pathogens is the chemical risk associated with methylmercury, a heavy metal that bioaccumulates in the aquatic food chain. The risk of mercury exposure depends on the type of fish consumed, not whether it is cooked or raw. High levels of mercury can damage the developing brain and nervous system of a fetus.
Larger, longer-lived, and predatory fish tend to have the highest concentrations of mercury. Ahi tuna, particularly Bigeye tuna, is a common ingredient in traditional poke and has a high mercury content. This fish, along with swordfish, king mackerel, and tilefish, should be avoided entirely during pregnancy.
Fish that are lower in mercury, such as salmon, shrimp, cod, and canned light tuna, are safe to eat in limited quantities (8 to 12 ounces per week). However, these lower-mercury options must be fully cooked to eliminate the pathogen risk before consumption. The nutritional benefits of consuming low-mercury, cooked fish, such as omega-3 fatty acids, are important for fetal brain development.
Safe Ways to Enjoy Poke Flavors
The vibrant flavors and textures of a poke bowl can still be enjoyed by pregnant individuals through safe substitutions. The most direct alternative is ensuring the protein component is fully cooked. Cooked, low-mercury options like salmon, shrimp, crab, or scallops can replace raw fish while offering a similar protein base.
For non-seafood alternatives, fully cooked chicken or firm tofu prepared with traditional poke marinades provide a safe substitute. Ingredients like edamame, avocado, seaweed, and the rice base are safe, provided they are fresh and handled under sanitary conditions. When ordering from a restaurant, confirm that the cooked protein is prepared and stored separately from any raw fish to prevent cross-contamination.
Ensure that any liquid ingredients, such as sauces or dressings, are made with pasteurized eggs if they contain them. Choosing a bowl with a cooked, low-mercury protein eliminates both the biological risk from pathogens and the chemical risk from high methylmercury levels.