What is ‘safe food’?

By ‘safe food’ we mean food that is free of pathogens (bacteria, viruses and parasites) that can cause illness in humans. Why is safe food important in pregnancy? Food that is safe to eat is important for pregnant women. While you are pregnant your levels of immunity are lower than usual, so you are at more risk of getting diseases carried by food. Your illness may also be worse than it would normally have been. Rarely, certain pathogens – such as those described later in this booklet – can cause miscarriage, still or premature birth, and serious illness or even death to newborn babies. The good news is that following simple rules on food safety can help prevent most foodborne illness. Remember the 4 Cs – clean, cook, cover, chill.

Food safety guidelines

Food often carries small numbers of germs. The food safety guidelines in this booklet are designed to reduce the risk of pathogens growing on food, or spreading from one type of food to another.

Buying safe food• always check the ‘use by’ or ‘best before’ date – if it is past the date, don’t buy it • check for damaged packaging – don’t buy dented tins, leaking cartons or bottles (e.g. milk), ripped boxes or packets, broken or pierced seals (e.g. yoghurt) • avoid swollen chilled food packages, and swollen cans • avoid products in loose vacuum packs (e.g. bacon – the packaging should be tight around the food, with no air) • avoid products that are mouldy, strangely coloured, or infested with insects • avoid chilled products that are not cold to the touch • avoid frozen products that are not frozen solid • avoid hot foods that are not steaming hot (e.g. cooked chickens).

Taking food home• at the supermarket, make sure raw meat and chicken is packed in a separate bag from other foods to stop raw meat juices from dripping onto other foods • always take food straight home, especially chilled and frozen foods – never leave food in a hot car • for chilled and frozen foods, if you have more than a 30 minute trip home or if the weather is hot, use a chilly bag or bin with an ice pack • when you get home, immediately transfer chilled and frozen foods into the fridge or freezer. Storing food To keep food fresh, and to slow any growth of pathogens, store it in the following ways:

In the fridge• the temperature should be between 2ºC and 4ºC – check the temperature daily (you can buy a fridge thermometer from hardware stores) • don’t let meat and chicken juices drip onto other foods • cover all cooked foods (e.g. with plastic wrap) • eggs should be stored in the fridge • meats should be marinated in a covered container in the fridge, not on the bench • leftover hot food should be put in the fridge as soon as it has stopped steaming; hot food will cool more quickly if put into a shallow dish • only store leftovers or cooked food in the fridge for two days – if it is not used by then, throw it out • leftovers must be reheated until steaming hot and must not be reheated more than once.

In the freezer • only freeze fresh, good quality food – freezing will not kill pathogens in food • only freeze small amounts of food at a time – otherwise the middle of the food might not get frozen quickly enough • freezer temperature should be between -15ºC and -18ºC (you can buy a freezer thermometer from hardware stores) • raw food should only be frozen once – leftovers can be frozen only one more time • cooked food should only be frozen once

In the pantry

• keep foods in airtight containers, or buy reusable bag clips (for closing packets)

• keep foods covered

• keep shelves clean – crumbs and spills attract pests. Cooking

• Make sure meat and chicken are completely thawed (defrosted) before you cook them

• Never thaw frozen food on the bench – it can be thawed in the fridge overnight, or in the microwave (using the defrost or lowest power setting)

• When defrosting foods like mince and casserole in the microwave, break them up a few times during thawing, and then immediately cook or reheat them

• Preheat the oven so that food cooks as quickly as possible

• Make sure that food is thoroughly cooked and steaming hot right through to the middle

• Make sure that meats are cooked until the juices run clear and there is no pinkness in the middle. This is important for chicken, beef, pork and minced meats (mince, sausages, meatloaf). Undercooked meat and chicken should not be eaten!

• Eggs should be well cooked (firm yolk and white) – don’t eat raw or undercooked eggs

• Vegetables should be washed before cooking

• Eat cooked food immediately, while it is still hot – don’t leave it to stand at room temperature. Reheating and microwaving Microwaves are quick and easy to use, but they don’t always cook or reheat food evenly, and may leave hot and cold spots in the food:

• When cooking in the microwave, stir food frequently to avoid uneven cooking

• Cover food with a suitable lid or microwave-safe plastic wrap (but don’t let the wrap touch the food) – covered food cooks or thaws more evenly

• Always leave food for the recommended standing time after cooking or reheating in the microwave – this is necessary for the food to finish cooking

• Make sure that reheated and cooked food is steaming hot right through to the middle.

Hand hygiene One of the most important things you can do to prevent illness from pathogens on food is to have clean hands! Drying is just as important as washing. Wash your hands thoroughly, using plenty of soap, for at least 20 seconds (sing two verses of Happy Birthday, while rubbing hands together vigorously), rinse them well, and then dry them completely for 20 seconds on a clean dry hand towel or two paper towels (sing another two verses). Keep hand towels only for hands, or use paper towels – don’t use the tea towel that is used to dry dishes! Use a fresh hand towel daily (or change it more often if it is wet).

Wash and dry your hands:

• before and after preparing food

• after handling raw meat and chicken (before you handle any other foods, or before you touch your face, mouth or eyes)

• after going to the toilet, helping a child go to the toilet, or changing a baby’s nappy

• after touching pets or farm animals

• after blowing or touching your nose, sneezing into your hand, or touching your hair or your mouth while preparing food

• after gardening

• after handling rubbish. Food safety in the kitchen To avoid contaminating food with pathogens:

• always use clean utensils (e.g. knives, spoons) when preparing foods; use hot soapy water or a dishwasher to wash dishes; let dishes air dry rather than drying with a tea towel. If you have to use a tea towel make sure it is changed at least daily

• use separate chopping boards and utensils when preparing raw foods which require cooking (especially meat and chicken), and cooked or ready-to-eat foods (e.g. salad)

• if you have only one chopping board and one knife, scrub them clean in hot soapy water and dry thoroughly in between using them for raw and for cooked/ready-to-eat foods

• never put cooked food back onto the same plate that contained the raw food – always use a clean plate (e.g. when barbecuing meat or chicken or fish)

• use separate sponges or cloths for the dishes, the bench and the floor (tip: use different colours, so you know which one is for which task)

• use paper towels (instead of a cloth or sponge) and disinfectant (e.g. bleach solution) to wipe up messy spills like raw meat or chicken juices from the bench or floor

• clean dish cloths or sponges (especially after use on the floor) by washing them in hot water (60ºC), or soaking in bleach solution for at least 1 hour, or microwaving the damp dish cloth for 1 minute on high, or putting them through a cycle in the dishwasher

• avoid coughing or sneezing over food

• don’t allow pets near food or on bench tops

• cover food to protect it from flies and other insects

• don’t prepare food for other people if you have an illness with diarrhoea or vomiting (which could be passed on through contaminating the food).

Safer Eating in Pregnancy

Food type What to do

Breads and cereals: Breads all types Ok to eat Cakes, slices, muffins etc plain Ok to eat with cream or custard Don’t eat (unless cream is newly opened, custard - home-made and fresh) Cereals breakfast cereals, rice, pasta etc OK to eat - refer to dairy products below for milk information

Dairy products: Cheese hard yellow cheese (e.g. cheddar, parmesan) Buy in small quantities cottage cheese, cream cheese etc. Buy in sealed packs; eat cold or cooked within two days of opening pack; don’t eat leftovers soft pasteurised cheese (e.g. brie, camembert, blue, feta, ricotta, etc. Don't eat unless heated until steaming hot. Butter all types Buy in small quantities; store in fridge; ideally eat within two days of opening pack Cream fresh, un-whipped or whipped, sour cream etc. Buy in sealed packs; eat within two days of opening pack; don’t eat leftovers Custard ready made chilled (packaged) Don’t eat unless heated until steaming hot home made Eat while hot immediately after cooking; don’t eat cold leftovers Milk pasteurised Ideally drink or use within two days of opening Un-pasteurised (raw) Don’t drink or use Yoghurt all types Check use by date; ideally eat within two days of opening pack

Eggs: Raw eggs In egg flips, eggnog, smoothies, home made mayonnaise etc. Don’t eat Cooked eggs Fried, scrambled, baked or poached Cook well (firm yolks, firm scrambled eggs)

Meat and poultry: Cooked meats Beef, pork, chicken, mince, sausages Cook thoroughly until steaming hot throughout, and until juices run clear, eat while hot, never eat rare or undercooked meats; don’t eat cold leftovers Processes meats Ham, salami, luncheon, pate, pastrami, biltong, jerky (dried meat) etc. Don’t eat unless heated until steaming hot Cold cooked poultry Any cold pre cooked poultry (e.g. chicken, turkey etc.) Don’t eat unless heated until steaming hot Raw meat Any raw meat, raw chicken or other poultry beef, pork etc. Don’t eat, don’t taste, or touch face, mouth or eyes while preparing; wash and dry hands well after touching raw meats

Seafood: Raw fish and seafood Any raw fish or seafood Don’t eat Smoked fish and seafood Chilled pre-cooked fish, oysters, mussels, salmon etc. Don’t eat unless heated until steaming hot Cooked fish and seafood Freshly cooked fish, mussels, oysters, scallops etc. Cook thoroughly until steaming hot throughout, eat while hot

Vegetables, salads and fruits: Fruit All fresh fruits Wash and dry well just before eating Vegetables All fresh vegetables Wash and dry well just before eating raw, or wash before cooking Frozen vegetables Cook; don’t eat uncooked frozen vegetables Salads Ready made salads and coleslaws from delis, salad bars etc Don’t eat Home made Wash and dry salad ingredients well just before making and eating salads Parsley Home grown and store bought Don’t eat raw, can use in cooked dishes

Miscellaneous: Leftovers Cooked foods Store uneaten leftovers covered in fridge; eat within two days; never eat cold leftovers – always reheat until steaming hot Tinned foods Tinned fruit, vegetables, fish, seafood, meat, sauces etc. Eat immediately after opening tin (hot or cold); store uneaten leftovers covered in fridge and eat hot (never cold) within two days Sauces and dressings Salad dressings (oil and vinegar), bought mayonnaise, tomato sauce etc. Store in fridge once opened Sushi Store bought (all types, even without raw seafood) Don’t eat Home made Use freshly cooked rice, and don’t use raw meat or seafood; eat immediately; don’t eat leftovers Stuffing Stuffing from chicken or turkey Don’t eat unless stuffing is cooked separately (in a dish); eat hot, store uneaten leftovers in fridge and eat hot within two days Hummus Store bought or home made Buy in sealed containers; store in fridge; eat within two days of opening or making

Foods that are eaten raw Fruits and some vegetables are often eaten raw. To get rid of pathogens, such as Listeria or Toxoplasma that may be on them, it is very important to thoroughly wash and dry them with a clean paper towel. Do this just before eating them. Salads should also be prepared just before eating.

Dairy productsDairy products such as milk, cheese and yoghurt are important sources of protein and calcium in pregnancy and their consumption is encouraged. Commercially produced New Zealand and imported dairy products are pasteurised and this kills any pathogens in the raw product. However, after opening these products, there is potential for contamination by pathogens that may lead to illness. Listeria can grow at refrigeration temperature to numbers that can result in an infection. For this reason, dairy products should be kept well covered to prevent contamination. They should ideally be consumed within two days of opening, or used in cooked foods after that two-day period. Soft cheeses (including brie, camembert, blue, ricotta, feta) may harbour pathogens and should not be eaten unless cooked until steaming hot. Raw milk and raw milk products (such as unpasteurised milk drunk on the farm and home-made cheeses made from unpasteurised farm milk) should be avoided.

Restaurants and takeaways

The principles of food safety are the same for takeaway foods as they are for foods prepared at home, and steaming hot food is likely to be safe. The main difference is that pregnant women have little control over the way in which the food is prepared. Consumption of high-risk restaurant or takeaway foods should be avoided. High-risk foods include pre-prepared foods such as sushi, salads and sandwiches. Foods that have been well cooked immediately before consumption can be considered safe e.g. deep fried and baked foods, hot pizza. Gardening and food safety Toxoplasma cysts may be present in garden soil. Even if you don’t own a cat, other people’s pets may use your garden. Pregnant women may be at risk of infection from gardening, either from handling soil or from breathing in dust from soil. If you choose to garden while pregnant, to reduce the risk you should:

• always wear gloves while gardening

• avoid touching your face, mouth or eyes while gardening

• avoid stirring up or breathing in dust from the soil

• wash your hands well after gardening (even if you have worn gloves). Pets, farm animals and food safety You can catch several illnesses from pets and farm animals, by handling or playing with pets and not washing your hands afterwards. Pets and farm animals can carry many food pathogens (this is not a complete list):

• cats: Toxoplasma, Campylobacter, Salmonella

• dogs: Campylobacter, Salmonella

• birds: Campylobacter, Salmonella

• farm animals: Listeria, Campylobacter, Salmonella, Cryptosporidium. To reduce the risk of getting illnesses from pets or farm animals while you are pregnant you should:

• wash and dry your hands well after handling pets or farm animals

• avoid cleaning up cat faeces or cat litter – get someone else to do it; if you must do it, wear gloves, wash your hands afterwards, and avoid breathing in dust from the cat litter

• be careful if you live or work on a farm: wear gloves if you feed out silage (Listeria grows in it) and wash your hands afterwards, avoid handling stillborn animals, buy pasteurised milk to drink (pregnant women should never drink unpasteurised milk or eat products made from it, such as yoghurt or cheese), don’t drink untreated water (boil it if it comes from a roof tank, well, bore, lake or stream).

Overseas travel and food safety

Travel to overseas countries, particularly developing countries, carries a higher risk of foodborne illness for any traveller. Some countries have extremely high rates of illness carried by food, and water supplies may not be safe. Pregnant women should seek expert travel advice from a local public health office or travel health clinic before travelling overseas. While overseas, take special care that food and water (including ice) are safe to eat and drink. Important causes of foodborne illness in pregnancy

Listeriosis

Listeria infection can occur at any time during pregnancy. Listeria infection generally results in mild flu-like symptoms including fever and muscle aches. In rare circumstances severe illness and premature labour may result, or the baby may be born with the infection and need treatment with antibiotics. Listeria is a bacterium commonly found in the environment, including in animal faeces, on plants, in soil and in water. Consequently, Listeria can occur on raw food or re- contaminate prepared food. Unlike most bacteria, Listeria can grow on food in the fridge. Listeria may contaminate a range of commonly consumed foods. By following the advice in this booklet you can reduce your risk of listeriosis.

Toxoplasmosis

Toxoplasma infection is uncommon in pregnancy as most people will be exposed to it early in life. A pregant woman may have no symptoms following infection or have an illness with swollen glands, fever, nausea or headache. Infection during pregnancy can result in miscarriage or foetal death or infect the baby, causing illness which may lead to brain damage, hearing and sight problems. Toxoplasma is a parasite commonly found in reptiles, birds and animals, especially cats. Therefore, foodborne infection can result from eating undercooked meats or salami-type meats (often uncooked), raw milk, and unwashed raw vegetables from the gardens of households with cats. So, to reduce your risk, it is important to wash your hands after animal contact, avoid foods that are more likely to contain Toxoplasma, and to follow the food safety guidelines.

Campylobacteriosis

Campylobacter infection is very common in New Zealand, and can occur at any time during pregnancy. The symptoms of Campylobacter infection are usually flu-like, followed by diarrhoea, abdominal pain, nausea, and vomiting. Miscarriage and premature labour can occur. Campylobacter is a bacterium commonly found in animals and the environment. Therefore, foodborne infection can result from eating undercooked meats (undercooked poultry meat has caused outbreaks), raw milk, and drinking nonchlorinated water. So, to reduce your risk, it is important to wash your hands after animal contact, avoid raw milk and untreated water, fully cook meats (especially on the BBQ), and to follow the food safety guidelines.

Other illnesses carried by food

Salmonella infection occurs quite commonly in New Zealand with an estimated 75 cases in pregnant women annually. Infection with the Salmonella bacterium causes headache, abdominal pain, diarrhoea and vomiting. Salmonella infection during pregnancy can cause stillbirth. Giardia is a parasite found all over New Zealand, and can be caught by drinking, swallowing or swimming in untreated water (from lakes, rivers, springs, wells, ponds). Food can be contaminated, especially raw food like fruit and vegetables. Wash raw foods well with safe water. It is very important to wash your hands properly after changing the nappies of young children who have Giardia infection. Symptoms of Giardia infection are diarrhoea, abdominal cramps and nausea, and the illness can last 4-6 weeks (occasionally longer). Cryptosporidium (Crypto for short) is a parasite similar to Giardia, and is also common in New Zealand. It can be caught in the same ways as Giardia. Crypto causes severe watery diarrhoea, and can be passed from an infected mother to her baby during the birth process. Both Giardia and Cryptosporidium cause unpleasant illness, which may be severe. To reduce your risk, drink and swim in safe water, wash your hands properly and follow the food safety guidelines.

Other Healthy Eating Tips

Pregnancy is also a time that changes nutritional requirements to meet the needs of both mother and child. A full discussion on the nutritional needs of pregnant women is contained in the Ministry of Health’s Eating for Healthy Pregnant Women (code 6002) and Your Pregnancy (code 1420) (www.healthed.govt.nz). Following are some of the key safety related nutritional issues:

Folic Acid

Folic acid is a vitamin that is needed for the formation of blood cells and new tissue. During early pregnancy the need for folic acid is higher. Folic acid is important for reducing the risk of having a child with a birth defect. It is recommended that a daily 0.8 mg supplement of folic acid be taken for four weeks prior to conception and for the first three months of pregnancy. If folic acid has not been taken before pregnancy it is still worth starting to take the supplements as soon as pregnancy is known or expected. The 0.8 mg folic acid supplements are available from pharmacies.

Mercury in Fish

There are important nutritional benefits for all people from eating fish. There are, however, unresolved issues around levels of mercury in some fish and potential impacts on the growing foetus. It is recommended that pregnant women, and women considering pregnancy, should limit their consumption of some types of fish to no more than four serves a week (100 g - 150 g per serve). Fish types to be mindful of are some of the longer lived and larger fish including shark, gemfish, swordfish, marlin, orange roughy, ling and fish caught in geothermal waters (such as trout). It is also recommended that pregnant women limit their intake of oysters due to high cadmium concentrations. Other fish, including canned fish, need not be limited.

Alcohol

There is no known safe level of alcohol consumption for pregnant women. Alcohol crosses the placenta so whatever a mother consumes, the foetus will also receive Excessive alcohol consumption is associated with Foetal Alcohol Syndrome (FAS) where the infant may have varying effects including intellectual impairment. Even at lower levels of alcohol consumption, infants may show behavioural and learning difficulties which have been linked to alcohol consumption. It is therefore preferable not to drink alcohol during pregnancy or when contemplating pregnancy. If alcohol is consumed it should only be in small amounts.

Caffeine

Any drinks containing caffeine, including coffee, tea and colas should be limited to three cups per day.