For decades, obstetricians and public health agencies have provided pregnant women with a standard list of foods to avoid: soft cheeses, deli meats, raw seafood, and unpasteurized dairy products. This guidance has undoubtedly prevented countless cases of listeriosis and other foodborne illnesses. However, the food supply has evolved substantially, and so has the epidemiology of foodborne pathogens. Recent outbreaks have implicated foods that fall entirely outside the traditional high-risk categories, exposing gaps in both consumer awareness and regulatory oversight. Pregnant women remain approximately ten times more likely than the general population to contract listeriosis (FDA, January 2026) and when Listeria reaches the fetus, it causes stillbirth in roughly 25% of those infections. A 2026 study from Michigan State University underscores the urgency: while many pregnant women experience only mild, flu-like symptoms or none at all, the bacterium can cross the placenta silently, leading to fetal brain infection in every stillbirth studied (MSU Today, March 2026). Understanding the full spectrum of risk, including unexpected sources, is therefore essential for protecting maternal and fetal health.
Listeria Monocytogenes: The Primary Concern
The bacterium Listeria monocytogenes stands apart from most foodborne pathogens because it can grow at refrigeration temperatures. While growth slows at or below 40 degrees Fahrenheit, the organism does not cease reproduction entirely, making refrigerated, ready-to-eat foods particularly vulnerable. Pregnant women face a heightened risk due to pregnancy-related immune suppression, which makes it harder for the body to fight off infections. Additionally, Listeria monocytogenes can cross the placental barrier and infect the fetus, whose immune system is not developed enough to resist. The outcomes are severe: listeriosis can lead to miscarriage, stillbirth, premature delivery, low birth weight, and infant death. Infected fetuses who survive may suffer long-term disabilities including intellectual disability, paralysis, seizures, blindness, and impairments of the brain, heart, or kidneys.
Pregnant women are about ten times more likely to get listeriosis than other healthy adults. For pregnant Hispanic women, the risk increases to approximately 24 times higher than the general population (FDA, January 2026), a disparity linked to higher consumption of queso fresco-type cheeses, which are highly susceptible to Listeria contamination. Approximately one in six all listeriosis cases occurs in pregnant women.
Unexpected Sources of Listeria
The traditional list of high-risk foods such as soft cheeses made with unpasteurized milk, deli meats, hot dogs, refrigerated smoked seafood, and raw sprouts remains valid. However, recent outbreaks have demonstrated that Listeria can contaminate foods that fall entirely outside these categories, creating risk where consumers least expect it.
Prepared meals and frozen foods represent a significant emerging category. Between August 2024 and November 2025, the Centers for Disease Control and Prevention (CDC) investigated a multistate outbreak of Listeria monocytogenes infections linked to prepared pasta meals (CDC, February 2026). A total of 28 people were infected across 19 states, with illness onset dates spanning more than 15 months. Of those, 27 were hospitalized, and seven deaths were reported across Arizona, Hawaii, Illinois, Michigan, Oregon, Texas, and Utah. One pregnancy-associated illness resulted in fetal loss. Sick individuals ranged in age from 4 to 92 years, with a median age of 75.
Investigators determined that prepared meals containing pasta, including chicken fettuccine alfredo purchased from the refrigerated section at Walmart and Kroger, were contaminated with Listeria and made people sick. The true number of illnesses was likely higher, as some individuals recover without medical care and are never tested for Listeria.
A separate listeria outbreak traced to frozen ready-to-eat meals has resulted in at least six deaths and 27 hospitalizations across 18 states. The CDC continues to note illnesses despite product recalls, as Listeria can persist in cold environments and may cross-contaminate refrigerator shelving and storage containers.
Plant-based beverages have also emerged as a surprising source. In July 2024, a national recall of Silk and Great Value plant-based milk products was issued following a listeriosis outbreak in Canada. The Canadian Food Inspection Agency (CFIA) reported 20 illnesses and three deaths linked to the outbreak (Government of Canada, October 2024).
The CFIA determined that a third-party facility used by plant milk manufacturer Danone Canada, called Joriki, was the source of contamination. During its investigation, the CFIA discovered that the facility did not properly implement environmental swabbing and finished product testing in adherence to Health Canada’s policy on Listeria monocytogenes in ready-to-eat foods. Production at the Pickering plant was stopped, and cleanup and renovations were required before manufacturing could resume. Health Canada had previously conducted a three-year survey of plant-based milk alternatives that found them to be a low risk for Listeria, underscoring that risk assessments can be outdated. A class-action lawsuit related to the outbreak was later settled for $6.5 million, with compensation ranging from $400 for mild symptoms to $150,000 for those who developed severe complications. The Canadian health minister noted that the outbreak “flips the board and makes us realize that we have to be much more vigilant” (CBC, October 2024) about plant-based products.
Sprouts: A Persistent and Overlooked Hazard
Raw sprouts deserve special attention because they are frequently overlooked by consumers who are otherwise careful about food safety. Listeria monocytogenes have been found on finished sprouts at a rate of 1.28%, and Salmonella on sprouts at 2.35% of seed samples and 0.21% of finished products (FDA, August 2017). The growing conditions for sprouts, like warm, humid environments, are ideal for bacterial proliferation, and the seeds themselves can harbor pathogens internally, making surface washing ineffective.
In October 2024, Jack and the Green Sprouts Inc. of River Falls, Wisconsin, recalled its 5-ounce packages of Alfalfa and Alfalfa Onion sprouts after routine testing revealed Listeria monocytogenes. The recall notice specifically warned that Listeria infection can cause miscarriages and stillbirths among pregnant women. The products had been distributed to grocery stores and co-ops in Minnesota, Wisconsin, and Iowa.
The FDA has long recommended that pregnant women avoid all raw sprouts, including alfalfa, clover, radish, and mung bean sprouts, as well as any dishes that contain raw sprouts, such as some Vietnamese pho, spring rolls, and sandwiches.
Toxoplasma gondii: The Under-Recognized Parasite
While Listeria receives the most attention in pregnancy food safety guidance, Toxoplasma gondii represents another significant threat that may be less familiar to consumers. The FDA identifies toxoplasmosis as one of the least known foodborne illnesses among consumers, yet its consequences for unborn children can be devastating. The parasite can be found in raw and undercooked meat, unwashed fruits and vegetables, water, dust, soil, and cat feces. Infants born to mothers who become infected for the first time just before or during pregnancy are at risk for severe toxoplasmosis, which can cause hearing loss, intellectual disability, and blindness.
Toxoplasmosis is one of the foodborne illnesses that can infect the fetus even if the mother does not feel sick (CDC, March 2025). Pregnant women can acquire toxoplasmosis from cats that spend time outdoors, as cats become infected by eating small animals or raw meat that carry the parasite. The parasite is then passed through the cat’s feces, and it does not make the cat sick, so pregnant women may not know if their cats are infected. Unlike Listeria, which is primarily a concern with refrigerated ready-to-eat foods, toxoplasmosis risk extends to handling cat litter and gardening in soil that may contain cat feces.
It is recommended that pregnant women avoid changing cat litter if possible, and if they must do so, wear gloves and wash hands thoroughly afterward. Gardening gloves are also recommended when working in soil.
E Coli: Another Serious Risk
In April 2024, the CDC and FDA investigated an E. coli outbreak linked to organic walnut halves and pieces sold in bulk bins at food co-ops and natural food stores in California and Washington. Twelve people from two states were infected, with six cases in California. Gibson Farms, Inc. recalled the affected walnuts with expiration dates between May 21, 2025, and June 7, 2025. While E. coli is not typically associated with nuts, this outbreak demonstrated that any food that comes into contact with contaminated surfaces or water can become a vehicle for pathogens. For pregnant women, E. coli infection can lead to hemolytic uremic syndrome (HUS), a serious kidney condition that can be life-threatening (Pakistan Journal of Medical Sciences, September 2020).
The Gap Between Guidelines and Reality
The traditional high-risk list has served as a useful starting point, but it does not capture the full scope of modern food safety risks. Prepared meals, frozen vegetables, plant-based milks, and nuts are not typically included in pregnancy food safety brochures, yet they have been linked to serious outbreaks.
A 2022 Salmonella outbreak linked to Jif brand peanut butter resulted in recalls of snack trays, chocolates, and other foods made with the contaminated product demonstrates that even shelf-stable foods are not immune to contamination. Salmonella can be found in many foods, including sprouts, vegetables, eggs, chicken, pork, fruits, and processed foods such as nut butters and frozen pot pies.
The FDA’s guidance for pregnant women encourages consumers to use ready-to-eat foods as soon as possible because the longer they are stored in the refrigerator, the higher the chance that Listeria monocytogenes can grow. This advice applies equally to foods that may not appear on the standard high-risk list. A refrigerated prepared pasta meal, a container of plant-based milk, or a bag of frozen mixed vegetables, none of which would raise red flags for most consumers, can support bacterial growth if contaminated and stored for extended periods.
Analysis and Next Steps
The understanding of food safety risks during pregnancy has evolved considerably in recent years. What is new includes the recognition that plant-based beverages, prepared refrigerated meals, frozen fruits and vegetables, and even nuts can serve as vehicles for pathogens that threaten maternal and fetal health. The 2024-2025 prepared pasta outbreak, which resulted in seven deaths and one fetal loss across 19 states, demonstrates that even foods purchased from major national retailers can be contaminated. The 2024 plant-based milk outbreak in Canada, which killed three people, shows that foods perceived as “healthy” or “natural” carry no inherent safety advantage. The 2021-2023 outbreaks linked to ice cream, queso fresco, and enoki mushrooms resulted in five stillbirths in just three years, underscoring that this is not a hypothetical concern.
This matters because the consequences for affected pregnancies are catastrophic. When Listeria reaches the fetus, stillbirth occurs in approximately one-quarter of cases. Infected newborns who survive may face lifelong disabilities including intellectual disability, blindness, seizures, and paralysis. The MSU study found that fetal brain infection was present in every stillbirth studied, and the research team emphasized that pregnancy involves a unique combination of physiological, behavioral, and clinical variables that cannot be captured by applying general immunocompromised population models. Public health agencies have been urged to use population-specific models when developing food safety guidance.
The populations affected are not limited to those who consume obviously risky foods. The plant-based milk outbreak affected consumers who believed they were making a healthy choice. The prepared pasta outbreak affected shoppers at Walmart and Kroger, mainstream retailers serving millions of Americans. The walnut E. coli outbreak affected customers at natural food stores and co-ops, establishments often associated with higher safety standards. No single retail channel or food category is immune.
What to do now requires action at multiple levels. For pregnant women and those who may become pregnant, the most important step is to recognize that the standard high-risk list is incomplete. Prepared refrigerated meals, including pasta dishes, should be heated until steaming hot before consumption, even if the package suggests they are ready-to-eat. Frozen fruits and vegetables intended for smoothies or raw consumption should be cooked unless specifically labeled as treated to eliminate pathogens. Plant-based milk products, like dairy milk, are safest when pasteurized. Consumers should verify that the products they purchase have been heat-treated. Raw sprouts of any kind should be avoided entirely, as no washing method can reliably remove pathogens. Refrigerated smoked seafood should only be consumed in cooked dishes. For those who handle cat litter or garden in soil, gloves and thorough hand washing are essential precautions.
For healthcare providers, the evidence supports expanding patient education beyond the traditional high-risk list. Discussion of prepared meals, frozen produce, and plant-based alternatives should be included in routine pregnancy counseling. Patients should understand that extended refrigeration increases risk for any refrigerated food, not just deli meats and soft cheeses.
For regulators and the food industry, the recent outbreaks underscore the need for more rigorous environmental monitoring across all product categories, including those not traditionally considered high-risk. The CFIA’s finding that the plant-based milk facility had not properly implemented environmental swabbing and finished product testing reveals a regulatory gap that must be addressed. Whole genome sequencing should be standard practice for pathogen surveillance, enabling rapid identification of outbreak sources. Facilities producing refrigerated ready-to-eat foods, whether dairy, meat, plant-based, or produce, must be held to consistent sanitation standards, and routine testing should be required regardless of perceived risk category.
Continued investigation into pathogen behavior in novel food matrices, including plant-based proteins and prepared meals, is essential for keeping food safety guidance current with the evolving food supply.
The goal of pregnancy food safety guidance is not to induce fear but to provide accurate, actionable information that protects both mother and child. As the food supply continues to evolve, so must the guidance. The foods that pose the greatest risk today may not be the same foods that posed the greatest risk a decade ago. Staying informed, checking recall notices, and maintaining basic food safety practices, such as cleaning, separating, cooking, and chilling, remain the most reliable defenses for every pregnancy.
