Foods to avoid during pregnancy in Singapore, with hawker swaps that are safe

The foods to avoid during pregnancy in Singapore are a short list: raw or undercooked seafood, meat and eggs (sashimi, raw cockles, half-boiled eggs), unpasteurised milk and soft cheeses, cold deli meats and pate, large high-mercury fish such as shark and swordfish, alcohol, and more than about two cups of kopi or teh a day. The Health Promotion Board names cockles, sashimi and half-boiled eggs by name, and KKH's dietitians add a hawker rule worth remembering: choose food cooked after you order, served hot. Almost everything else, from chicken rice to laksa, is fine with a small tweak. Below is a safe-swap table for the hawker centre, the reason behind each food, and what to do if you feel ill after eating something risky.

Safe swaps at the hawker centre

These swaps come from HPB's pregnancy nutrition booklet, KKH's dietitians on HealthXchange, Families for Life and SFA. Ate one of the "avoid" foods before you knew? Don't panic. The NHS says a small amount is unlikely to affect your baby if you didn't get ill.

Raw and undercooked meat, seafood and eggs

KKH's dietitians say raw or undercooked meat, eggs and seafood can carry salmonella, E. coli and listeria, and that food should be served hot, not at room temperature, because bacteria multiply as it cools. Families for Life, in an article by a KKH obstetrician, says eggs should be cooked until both the white and the yolk are solid.

In Singapore that means skipping, until after the birth:

• Sashimi, sushi with raw fish, raw oysters and raw cockles (hum)
• Runny or half-boiled eggs, and raw-egg sauces such as homemade mayonnaise, hollandaise or Caesar dressing
• Rare or medium-rare beef and pink minced meat
• Raw shellfish at buffets and steamboat, unless you cook it through yourself

SFA says pregnant women should avoid raw or undercooked bivalves (cockles, clams, oysters and mussels), eat only shells that open during cooking, and ask an eatery to cook a dish more if it arrives undercooked. SingHealth adds that most hepatitis A caught in Singapore comes from raw or partly cooked cockles or oysters.

Cooked versions are fine: fully cooked fish and shellfish, hard-boiled or well-fried eggs, and well-done meat.

High-mercury fish (keep eating the rest)

Fish is good for you in pregnancy, so the aim is to choose well, not to cut it out. Families for Life says cooked fish and shellfish can be eaten two or three times a week.

The worry is mercury, which builds up in large, long-lived fish. KKH's dietitians point to the US Food and Drug Administration's advice to avoid shark, swordfish, king mackerel, tilefish and bigeye tuna in pregnancy, and note that SFA (formerly AVA) monitors mercury in imported fish and recommends eating a variety. That makes shark's fin soup one to pass on at wedding dinners for now. With tuna, sources differ: Families for Life lists it among the fish to avoid, while the NHS caps it at 4 cans or 2 tuna steaks a week. Choose smaller fish more often: salmon, seabass, threadfin (ngoh her), pomfret, sardines and ikan bilis.

Unpasteurised dairy and soft cheeses

KKH's dietitians say soft cheeses and pate may carry listeria, which can cause food poisoning and lead to miscarriage or stillbirth. HPB's booklet lists unpasteurised milk and soft cheeses such as blue, brie, feta and camembert.

Hard cheeses such as cheddar, Swiss and parmesan, and processed cheese, are safe if made with pasteurised milk, KKH says. Supermarket milk in Singapore is almost all pasteurised, so your morning Milo or a cheese toastie is fine. With imported or artisanal cheese, check the label for "pasteurised". A soft cheese cooked until it's steaming hot, like a baked brie, is fine too.

Cold cuts, pate, smoked fish and other chilled ready-to-eat food

These feel cooked, so they get overlooked, but listeria can grow in chilled food even in the fridge. SFA says listeria infection is rare but can be fatal in pregnancy, advises against dry-cured raw ham and salami, and says to reheat ready-to-eat meats until they're steaming hot.

• Cold ham, salami, pepperoni, chorizo and prosciutto, unless heated until steaming
• All pate, including vegetable pate, and liver pate also carries high vitamin A
• Cold-smoked salmon and gravlax, unless cooked
• Sandwiches, salads and cut fruit that have sat out unrefrigerated

Caffeine: kopi, teh and bubble tea

You don't have to give up coffee. KKH's dietitians suggest no more than 200 mg of caffeine a day, about 2 cups of regular coffee or tea, and HPB says no more than two cups of caffeinated drinks a day. They also suggest not drinking tea or coffee within an hour of a main meal, because it reduces how much iron you absorb.

Bubble tea, milk tea, green tea, cola and dark chocolate all count, and our guide to coffee while pregnant adds them up for you. For scale, the NHS gives about 100 mg for a cup of instant coffee and 75 mg for a cup of tea, and coffee-shop coffee can have more. If coffee is part of a wider run of tiredness and common pregnancy discomforts, mention it to your doctor.

Alcohol, liver, herbal soups and tonics

There's no safe amount of alcohol to drink in pregnancy, so the safest choice is none, and that goes for tiramisu and rum cake too. Alcohol cooked into a dish is a different matter: KKH's dietitians say small amounts of alcohol in food are fine if the dish simmers for at least 30 minutes with the lid off, so the alcohol can evaporate. That covers many rice-wine and confinement-style dishes. Our guide to alcohol and smoking in pregnancy explains the risks and where to get help.

Liver is very high in vitamin A (retinol), and too much can harm a developing baby. Have it rarely and in small amounts, and avoid high-dose vitamin A supplements.

For traditional foods, Families for Life says bird's nest and chicken essence are considered safe in moderation. For herbal supplements and tonics, check with your doctor first. Herbal teas are generally fine in small amounts, but check the blend, and take raspberry leaf tea only if your doctor agrees. For honey, peanuts, soy milk, kombucha and saffron, see our quick answers on what pregnant women can eat.

Old wives' tales you can ignore

KKH's dietitians took on the common pregnancy food myths. There is no documented case of miscarriage from eating "cooling" foods such as papaya, pineapple or kangkong, and no evidence that seafood in pregnancy gives your baby skin problems. The real rule for seafood is that it should be well cooked and freshly prepared.

If you feel ill after eating

Food poisoning in pregnancy can dehydrate you quickly, and Families for Life notes that some bacteria can cross the placenta. Sip fluids or oral rehydration salts, and see a doctor if you have a fever, can't keep fluids down or have severe tummy pain. Go to hospital straight away if your baby is moving less than usual. Our guide to food poisoning while pregnant covers symptoms, safe rehydration and when to go to KKH.

Eating out and at home

1. Order food cooked after you order and served hot.
2. Ask for raw cockles and raw garnishes to be left out or cooked through.
3. At buffets and steamboat, cook your own portions fully and skip the raw bar.
4. Wash fruit and salad vegetables at home, and choose freshly cut fruit over platters that have sat out.
5. Keep raw and cooked food apart at home, use separate chopping boards, and don't leave cooked food out for hours in our heat.

When in doubt, ask one question: is this freshly cooked and hot, or raw, chilled or sitting out? Hot and fresh is almost always the safe choice.

Cravings, gestational diabetes and your own needs

Cravings, nausea and aversions vary. If smells turn your stomach, work around them; our morning sickness remedies guide has ideas. If you're managing blood sugar, see our gestational diabetes diet guide. For what to eat more of, including iron, folate and calcium, read our guide on eating well during pregnancy, or browse our full blog library.

Frequently asked questions

Is half-boiled egg in my kaya toast set safe?

Not while you're pregnant. HPB lists half-boiled eggs among foods to avoid because of salmonella. KKH's dietitian suggests asking for the eggs hard-boiled; the toast and kopi are fine.

How much kopi can I have when pregnant?

Up to 200 mg of caffeine a day, which KKH's dietitians put at about 2 cups of regular coffee or tea. HPB says no more than two cups of caffeinated drinks. Count bubble tea and teh too.

Can I eat laksa, chicken rice and char kway teow?

Yes, when they're freshly cooked and hot. Ask for the cockles to be left out or cooked through, and choose chicken rice from a stall where the chicken is freshly cooked rather than sitting out for hours.

Is pineapple or papaya dangerous in pregnancy?

No. KKH's dietitians say there is no documented case of miscarriage from eating these "cooling" fruits.

I ate something on the avoid-list before I knew I was pregnant. What should I do?

Try not to worry. The NHS says a small amount is unlikely to affect your baby if you didn't get ill. Mention it at your next check-up, and see a doctor if you get a fever, chills or a flu-like illness.