Can I eat smoked salmon while pregnant?

The verdict

Cold smoked salmon, the thin orange slices sold in vacuum packs and served on bagels and blinis, is restricted in pregnancy in the UK, Ireland, the US, Australia and New Zealand.

The Food Standards Agency's wording is direct: pregnant women or people who have a weakened immune system are more likely to suffer severe symptoms from listeria infection and are advised to avoid eating ready-to-eat cold-smoked or cured fish products, such as smoked salmon or gravlax. The NHS puts the same food in its foods to be careful with, saying cold-smoked and cured fish, like smoked salmon, must be cooked until steaming hot.

ACOG lists refrigerated smoked seafood among foods to avoid. The FDA says avoid refrigerated smoked seafood unless it is in a cooked dish, such as a casserole, and notes these products are most often labelled nova-style, lox, kippered, smoked or jerky. FSANZ lists smoked ready-to-eat seafood in its higher-risk group. Ireland's HSE lists raw or smoked fish among foods to avoid.

Cooked smoked salmon is a different matter, and the FSA explicitly names it as a safer alternative.

Why cold-smoked fish is not cooked fish

The name misleads people, and it is worth being precise about the process.

Cold smoking is a curing method, not a cooking method. The fish is cured, typically in salt, and then smoked at a low temperature that deliberately does not cook it. The FSA describes the result: ready-to-eat cold smoked fish is normally labelled as smoked fish on its packaging, has been cured and then smoked at a low temperature but is not cooked through, and typically comes in thin slices. Cold-smoked or cured salmon is thinly sliced, orange, pink or red, and feels slightly moist to touch.

Nothing in that process reaches a temperature that kills listeria. What you have at the end is a moist, ready-to-eat, refrigerated fish product with a long shelf life, which is close to an ideal environment for a bacterium that grows in the cold.

Hot smoked salmon is genuinely cooked: it is smoked at a temperature high enough to cook the flesh, and it comes out flaky and opaque rather than translucent and sliceable. UK guidance and the FSA's smoked fish advice are written about cold-smoked and cured products. If a pack is not clearly labelled hot smoked, treat it as cold smoked.

Gravlax, lox and cured fish

Gravlax is cured in salt, sugar and dill and never smoked at all. The FSA names it alongside smoked salmon, because curing and cold smoking present the same problem. Lox is a brine-cured salmon; the FDA names lox and nova-style among the labels to watch for.

The same logic covers cold-smoked trout, cold-smoked mackerel slices, smoked halibut and smoked cod that is sold sliced and ready to eat.

What counts as cooked, and what does not

The FSA is unusually specific here, and this is the part most people get wrong.

Its safer alternatives are cooked smoked fish in dishes such as quiche, fish cakes, pie or gratin, because cooking will kill any listeria that may be present; tinned or canned smoked fish; and thoroughly cooked fish fillets, fresh or frozen. If you are cooking smoked fish yourself, it says, make sure it is steaming hot all the way through and served or chilled immediately, and cooked smoked fish may be served cold after being chilled in the fridge.

Then comes the warning that matters: care should be taken with adding cold-smoked or cured fish to dishes like cooked pasta or scrambled eggs, because warming it through as you prepare your meal will not heat the fish to a high enough temperature to kill listeria.

So smoked salmon stirred into hot scrambled eggs at the end is not cooked smoked salmon. Smoked salmon draped over hot pasta is not cooked smoked salmon. Smoked salmon baked into a quiche for forty minutes is. A salmon fishcake fried through is. A tin of smoked salmon or smoked mackerel is shelf-stable and heat-processed and does not carry the concern at all.

The bagel, the canape and the Christmas platter

A bagel with cream cheese and smoked salmon is the single most searched version of this question. The cream cheese is fine; pasteurised cream cheese is on the NHS safe list and in the FSANZ safer alternatives column. The smoked salmon is the restricted part.

Blinis with smoked salmon at a party are worse than the same slice from a fridge at home, because the FSA advises eating ready-to-eat food within four hours of leaving the fridge, or two hours on a very warm day, and a canape platter routinely exceeds both.

If you want the flavour without the restriction, hot smoked salmon flakes, tinned salmon, cooked salmon fillet chilled and flaked, or smoked mackerel pate that has been baked are all workable substitutes. Salmon itself is on the FDA's Best Choices list for low mercury and is one of the oily fish the NHS wants pregnant women to eat, within the limit of two portions of oily fish a week.

If you have already eaten some

A slice of smoked salmon is a low risk, not a high one. Listeriosis is rare; the FSA notes it causes few or no symptoms in most healthy adults. The NHS's general position on foods that should have been avoided is that a small amount, if you did not become ill, is unlikely to affect your baby.

The reason it is worth knowing about is the long incubation and the mild presentation. ACOG says symptoms may appear as late as two months after eating contaminated food, and that even if you do not feel very sick you can pass the infection to your fetus. Fever, chills, muscle aches, headache, stiff neck, confusion, loss of balance or an upset stomach in the weeks afterwards all warrant a same-day call to your midwife or GP.

Tell them you ate cold smoked fish. Listeriosis is confirmed by a blood culture that nobody orders without a reason to, and it is treated with antibiotics.

Where guidance differs

Hardly at all, which makes this one of the more settled questions in pregnancy food advice. Every authority here restricts cold-smoked and cured fish, and every one of them offers cooking as the route back.

The only real differences are of phrasing. The FSA says avoid. The NHS says be careful with, and cook until steaming hot. The FDA says avoid unless it is in a cooked dish. FSANZ folds it into chilled ready-to-eat seafood generally. The HSE lists smoked fish flatly among foods to avoid.

What none of them restricts is salmon. The fish is not the problem; the curing process is. Cook it and it stops being a smoked ready-to-eat food and starts being dinner.