Pregnancy needs no extra calories at first, but a few foods matter more

Key takeaways

• A 2024 Listeria outbreak traced to meats sliced at deli counters hospitalized 60 people and killed 10, and CDC advised pregnant people to skip deli meat or heat it to 165°F¹².
• CDC says pregnant women are 10 times more likely to get a Listeria infection, and in 2009 to 2011 about 1 in 5 pregnancy-related cases ended in a pregnancy loss or a newborn’s death³⁴.
• You need no extra calories in the first trimester, then about 340 more a day in the second and 450 more in the third, according to the American Heart Association⁸.
• Federal fish advice, last updated in 2021, calls for 8 to 12 ounces of lower-mercury fish a week in pregnancy, yet the FDA reported that more than 20% of pregnant women ate no fish in the previous month⁵¹⁵.
• The 2025–2030 Dietary Guidelines name iron, folate and iodine as top pregnancy priorities and say pregnant women should avoid alcohol completely⁹.

In July 2024, investigators traced a Listeria outbreak to meats sliced at deli counters, including liverwurst made at a Boar’s Head plant in Jarratt, Virginia¹. By the end, 61 people in 19 states had been infected. Sixty were hospitalized, and 10 died¹².

One of the sick was pregnant. She recovered and stayed pregnant¹. Not every Listeria pregnancy ends that way. CDC’s advice to pregnant people, adults 65 and older and people with weakened immune systems: skip deli meat, or heat it to 165°F or until steaming hot².

The plate itself changes less in pregnancy than many people expect. In the first trimester, you need no extra calories at all⁸. What changes is how much rides on a few foods.

Some carry outsized risk, like cold deli slices and raw-milk cheese. Others carry outsized benefit and get skipped anyway. Low-mercury fish is the clearest example⁵⁶.

This guide is food first. Prenatal vitamins get their own companion article.

Before pregnancy, the folate window opens early

The neural tube, which becomes a baby’s brain and spinal cord, forms in the first weeks after conception, and many pregnancies aren’t planned, so the months before pregnancy count too¹⁰¹¹.

Folate is the headline nutrient. The 2025–2030 Dietary Guidelines for Americans, released in January 2026 by the federal health and agriculture departments, point pregnant women to folate-rich greens and legumes⁹.

Fortified grains add more. Since 1998, certain enriched cereal grain products in the U.S. have carried added folic acid, and in 2016 the FDA began allowing companies to add it to corn masa flour, the base of many tortillas¹⁰.

Food alone still falls short for this job. In 2023, the U.S. Preventive Services Task Force (USPSTF), an independent expert panel, concluded that people who could become pregnant don’t get optimal amounts from fortified foods¹⁰. Our prenatal supplements article covers the folic acid pill the panel recommends.

One more nutrient takes planning: our iodine article explains why plant milks and sea salt can leave an iodine gap.

Eating for two starts later, and weight ranges are guides

“Eating for two” overstates it. The American Heart Association’s 2025 pregnancy nutrition sheet says you need no extra food in the first three months⁸. After that, it suggests about 340 more calories a day in months four through six and about 450 more in the last three months⁸.

Twins call for about 600 extra calories a day starting in month four⁸. By our math, 340 calories is about a sixth of a 2,000-calorie day: a hearty snack, not a second dinner. Breastfeeding raises needs again, the Dietary Guidelines say, without naming a number⁹.

How much to gain can be a loaded question. The U.S. ranges come from a 2009 Institute of Medicine committee, now part of the National Academies⁷. They depend on your body mass index (BMI), a ratio of weight to height, before pregnancy:

Pre-pregnancy BMI	Suggested total gain
Under 18.5	28 to 40 pounds
18.5 to 24.9	25 to 35 pounds
25 to 29.9	15 to 25 pounds
30 or higher	11 to 20 pounds

The first three ranges match guidance from 1990. The range for a BMI of 30 or higher was new in 2009⁷.

The committee linked gaining within range to lower risks. Gaining more was tied to keeping extra weight after birth, cesarean delivery, preterm birth and larger babies with more body fat. Gaining too little was tied to poor fetal growth and early delivery⁷.

The committee also said that landing outside the range doesn’t mean a person will have problems⁷. It wrote the ranges for U.S. women and noted that they may not fit places where women are much shorter or thinner⁷.

Treat the range as the start of a conversation, not a grade. Your clinician can advise you if you’re gaining more or less than expected⁸.

If weighing in stirs up old struggles with food or restriction, say so. The National Alliance for Eating Disorders runs a support and referral helpline at 1-866-662-1235, weekdays from 9 a.m. to 7 p.m. Eastern. If you’re in crisis, call or text 988.

Low-mercury fish is the food many pregnant women skip

The Dietary Guidelines name low-mercury, omega-3-rich seafood such as salmon, sardines and trout as a pregnancy food⁹. But some fish carry more mercury than others, and federal advice on that tension has swung. After a 2001 federal mercury advisory, pregnant women’s fish intake dropped by more than one serving a month, researcher Emily Oken and colleagues reported in 2003⁶. The 2004 federal advice capped fish at two servings a week, while maternal health groups were urging at least two⁶.

Oken’s later work in Project Viva, a U.S. study of mothers and children funded by the National Institutes of Health, found no evidence that more fish in pregnancy harmed children, and some evidence that it helped their thinking skills⁶. In a 2013 pilot trial, advice to favor low-mercury fish raised pregnant women’s intake of DHA, an omega-3 fat, without raising their mercury exposure⁶.

The FDA and the Environmental Protection Agency revised their joint advice in July 2019, adding more on fish’s benefits⁵. In October 2021 they updated it again to match the 2020–2025 Dietary Guidelines, without moving any fish between categories¹⁵. The pregnancy advice stayed the same: fish 2 to 3 times a week, or 8 to 12 ounces in all, for people who are pregnant or breastfeeding¹⁵. A chart sorts more than 60 kinds of fish into Best Choices, Good Choices and Choices to Avoid⁵.

Many people still fall short. In its 2019 update, the FDA reported that more than 20% of pregnant women ate no fish in the previous month, and half of those who did ate less than 2 ounces a week⁵.

Picking well is easier than it sounds:

• Lower mercury: shrimp, canned light tuna, salmon, pollock and catfish, per CDC³.
• Higher mercury, so skip them: shark, swordfish, king mackerel and tilefish, per CDC, plus bigeye tuna, per the American Heart Association³⁸.
• Cook it: bring fish to 145°F, or until the flesh is opaque and flakes with a fork. Skip raw fish such as sushi, sashimi and ceviche, and refrigerated smoked seafood like lox. Canned and shelf-stable smoked fish are safer swaps³.

If you rarely eat fish, our fish oil article covers what omega-3 pills have shown in pregnancy.

Listeria is rare, serious and mostly preventable

CDC says pregnant women are 10 times more likely to get a Listeria infection³. Its scientists put numbers to that in a 2013 report covering 2009 to 2011⁴. Of 1,651 serious cases nationwide, 14% were tied to pregnancy⁴.

Among those 227 pregnancy cases, 46, or about 1 in 5, ended in a pregnancy loss or a newborn’s death⁴. The absolute risk is still small. Pregnant women got sick at a rate of 3.0 per 100,000 a year, or about 1 in 33,000 by our math⁴. Pregnant Hispanic women had a rate of 7.0 per 100,000, which the report put at 24 times the rate in the general population⁴.

Cheese was behind 6 of the 12 outbreaks in that report, and in five of them the cheese was labeled pasteurized⁴. Four involved Mexican-style cheeses⁴. That history explains why CDC now lists queso fresco-type cheese as riskier even when it’s made with pasteurized milk³. Heated to 165°F or until steaming hot, pasteurized soft cheese moves to CDC’s safer column³.

Most of the risk sits in a short list of foods, and CDC’s swaps handle it³:

• Deli meats, hot dogs and dry sausages: heat to 165°F or until steaming. Choose shelf-stable pâté over refrigerated pâté.
• Deli salads: make your own instead of buying premade chicken, tuna, egg or potato salad.
• Cheese: pick hard cheeses, or cottage, cream, feta or mozzarella made from pasteurized milk. Heat pasteurized soft and deli-sliced cheeses until steaming. Skip raw-milk soft cheeses such as brie, camembert and blue-veined types, and skip unheated queso fresco-type cheese, pasteurized or not.
• Milk and juice: choose pasteurized, or bring unpasteurized juice or cider to a rolling boil for at least 1 minute. Our raw milk article explains the risks.
• Sprouts and melon: cook sprouts until steaming. Don’t leave cut melon out for more than 2 hours (1 hour above 90°F), and keep it in the fridge for no more than 7 days.
• Eggs and dough: cook eggs until firm, and skip homemade eggnog, Caesar dressing and raw cookie dough or batter.

Symptoms in pregnancy can be as mild as fever, aches and tiredness, and they usually start within 2 weeks². The box below says when to call.

Toxoplasma: meat matters as much as the litter box

Toxoplasma is a parasite. An infection before pregnancy poses little risk to a baby, but a new infection shortly before or during pregnancy can pass to the fetus¹²¹³.

Most infected babies look normal at birth, CDC scientists wrote in 2000, but many later develop vision and learning problems¹². Some are born with intellectual disability, blindness or epilepsy, California health officials note¹³.

Because the illness isn’t nationally reportable, that 2000 CDC report could only estimate that 400 to 4,000 U.S. babies are born with it each year¹². Cats get the attention, but food is a big route. A U.S. Department of Agriculture estimate cited in the CDC report blamed contaminated meat for about half of U.S. cases¹². What helps:

• Cook meat to safe temperatures: 145°F plus a 3-minute rest for whole cuts of beef, pork, lamb and veal; 160°F for ground meat; 165°F for poultry³.
• Clean up: peel or wash produce, and wash cutting boards, knives and hands after handling raw meat¹².
• Garden in gloves, then wash your hands¹²¹³.
• Hand off the litter box. If you must change it, wear gloves, wash up and change it daily. The parasite needs several days in litter to become infectious¹²¹³.
• Keep cats indoors, and feed them commercial food, not raw meat¹²¹³.

Caffeine, alcohol and gestational diabetes

Caffeine. The American Heart Association says less than 200 mg a day is considered OK in pregnancy, and advises checking with your clinician⁸. Our caffeine article covers the debate over that line and why pregnancy slows how fast you clear caffeine.

Alcohol. The 2025–2030 Dietary Guidelines say pregnant women should avoid alcohol completely⁹. Our alcohol article covers CDC’s view that no amount is known to be safe.

Gestational diabetes. If a glucose test shows gestational diabetes, ask your care team for a referral to a registered dietitian who can build meals around your readings. Don’t drop whole food groups on your own; the guidelines’ priority nutrients come from many of them⁹. Our article on insulin’s partner hormones explains why blood sugar tends to rise later in pregnancy.

Plant-based pregnancy works best with a plan

Some readers eat mostly or entirely plants, for health, ethics or tradition. That can work in pregnancy, but it takes planning. The new Dietary Guidelines say vegetarian diets often fall short in vitamins D and E, choline and iron⁹. Vegan diets show broader gaps, including vitamin B12, calcium, zinc and protein⁹.

Choline is easy to miss. Eggs are the Dietary Guidelines’ named choline food for pregnancy⁹, and our prenatal supplements article gives the daily target. If you skip eggs, ask a dietitian how to cover it.

B12 is not optional on a vegan diet, and iodine needs a deliberate source if you skip dairy and iodized salt. Our vegan diet and iodine articles cover both, and a dietitian can help you plan, ideally before pregnancy.

There’s a natural-health lesson here. The foods doing the most good in pregnancy are ordinary ones: beans, greens, eggs, fish, dairy and meat⁹. Many of the riskiest items are ready-to-eat foods sliced or mixed by someone else, along with raw milk and raw fish³. A kitchen built on whole foods, cooked with care, covers most of this guide.

The pregnancy plate planner

Use this for shopping and meal planning. It summarizes the sources cited and doesn’t replace your clinician’s advice.

Food group	Why it matters	Good choices	Safety notes	Source
Greens and legumes	Folate, a top pregnancy priority	Beans, lentils, dark leafy greens	Wash produce; cook sprouts until steaming	39
Meat and poultry	Iron, a top pregnancy priority	Iron-rich meats	Poultry 165°F; whole cuts 145°F plus rest; ground meat 160°F; deli meat heated to 165°F	39
Eggs	Choline, which the guidelines tie to eggs	Eggs cooked firm	No raw-egg foods such as homemade eggnog or raw dough	39
Seafood	Omega-3 fats such as DHA	Salmon, sardines, trout, shrimp, pollock, canned light tuna	8 to 12 oz a week; cook to 145°F; skip shark, swordfish, king mackerel, tilefish, bigeye tuna	38915
Dairy	Calcium	Pasteurized milk and yogurt, hard cheeses	No raw milk or unheated queso fresco-type cheese; heat soft and deli-sliced cheese until steaming	39
Drinks	Fluids without the risks	Water, pasteurized juice	Caffeine under 200 mg; no alcohol; boil unpasteurized juice 1 minute	389

How to use it: improve one row a week, and bring the planner to a prenatal visit if you skip a whole food group.

What the evidence shows

Claim	Evidence rating	What it rests on
Heating deli meats and choosing pasteurized dairy lowers Listeria risk	Strong evidence	CDC guidance and outbreak investigations tracing cases to cold deli meat and soft cheese234
Gaining within the 2009 ranges is linked to fewer complications	Strong evidence of a link	National Academies committee review; outside the range isn’t a guarantee of problems7
Eating low-mercury fish in pregnancy helps children’s development	Promising but early	Cohort data and a pilot trial found benefits and no harm6
You need extra calories from the first weeks	Evidence says no, or unsafe	Heart association guidance: no extra calories in the first trimester8
Some alcohol in pregnancy is fine	Evidence says no, or unsafe	Guidelines say avoid it completely9

Questions readers ask

The bottom line

Pregnancy asks for more food only after the first trimester, and less than “eating for two” suggests. The bigger changes are about choices: low-mercury fish two or three times a week, folate-rich foods before and during pregnancy, eggs for choline, and a plan for any food group you skip.

Food safety carries the highest stakes. Heat deli meats and soft cheeses until steaming, stick with pasteurized milk and juice, cook meat and fish through, and hand off the litter box. Weight-gain ranges are guides for a conversation, and your care team is there for any symptom or worry.

Related reading

• Folic acid earned its place, while other prenatal nutrients are still proving theirs
• Eleven of 12 Best-Selling Prenatals Missed a Label Amount. Check Yours
• A Decade of Big Fish Oil Trials Shrank the List of What It Does
• A big caffeine dose 12 hours before bed can still cut deep sleep
• Vegan diets can be healthy for adults, and B12 is not optional

Sources

1. Centers for Disease Control and Prevention. “Investigation Update: Listeria Outbreak Linked to Meats Sliced at Delis.” Final update November 21, 2024. cdc.gov
2. Centers for Disease Control and Prevention. “Listeria Outbreak Linked to Meats Sliced at Delis.” Published August 14, 2024; updated January 31, 2025. cdc.gov
3. Centers for Disease Control and Prevention. “Safer Food Choices for Pregnant Women.” First published May 15, 2024; updated January 31, 2025. cdc.gov
4. Silk BJ, et al. “Vital Signs: Listeria Illnesses, Deaths, and Outbreaks — United States, 2009–2011.” Morbidity and Mortality Weekly Report, 2013;62(22):448. cdc.gov
5. U.S. Food and Drug Administration. “FDA issues revised advice about eating fish for women who are or might become pregnant, breastfeeding mothers, and young children.” Constituent update, July 2, 2019. fda.gov
6. National Institute of Environmental Health Sciences. “Benefits of eating fish during pregnancy.” Environmental Factor, June 2023. niehs.nih.gov
7. National Academies (Institute of Medicine). “Report Updates Guidelines on How Much Weight Women Should Gain During Pregnancy.” News release on “Weight Gain During Pregnancy: Reexamining the Guidelines,” May 28, 2009. nationalacademies.org
8. American Heart Association, Go Red for Women. “Nutrition Tips for a Healthy Pregnancy.” 2025. goredforwomen.org
9. U.S. Department of Health and Human Services and U.S. Department of Agriculture. “Dietary Guidelines for Americans, 2025–2030.” January 2026. cdn.realfood.gov
10. U.S. Preventive Services Task Force. “Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication.” Final recommendation, August 1, 2023. uspreventiveservicestaskforce.org
11. NIH Office of Dietary Supplements. “Dietary Supplements and Life Stages: Pregnancy: Fact Sheet for Health Professionals.” Accessed October 2026. ods.od.nih.gov
12. Lopez A, Dietz VJ, Wilson M, Navin TR, Jones JL. “Preventing Congenital Toxoplasmosis.” Morbidity and Mortality Weekly Report Recommendations and Reports, March 31, 2000;49(RR-2):57. cdc.gov
13. California Department of Public Health. “Toxoplasmosis.” Page last updated May 2017. cdph.ca.gov
14. MotherToBaby, Organization of Teratology Information Specialists. Home page. Accessed October 2026. mothertobaby.org
15. U.S. Food and Drug Administration. “FDA Issues Updated Advice about Eating Fish.” Constituent update, October 28, 2021. fda.gov