Raw Milk & Unpasteurized Juice or Cider

Pregnancy

FDA and CDC state that raw milk may contain several illness-causing germs; FDA and CDC identify pregnant people as more vulnerable to serious foodborne illness. FoodSafety.gov says unpasteurized juice or cider can cause foodborne illness, has been linked to E. coli outbreaks, and lists pasteurized juice or a rolling boil for at least 1 minute as alternatives. ACOG and NHS state that listeriosis can cause miscarriage or stillbirth and serious newborn illness; ACOG also lists preterm labor. In the 1985 Los Angeles Listeria outbreak, Linnan et al. linked one Mexican-style soft-cheese brand to the outbreak, and investigators said the cheese plant commonly used unpasteurized milk. This was a cheese outbreak, not an estimate of risk from drinking plain raw milk or from one serving. Costard et al. modeled reported U.S. outbreaks involving cow's milk and cheese: 87 outbreaks, 750 laboratory-confirmed illnesses, and 215 hospitalizations were included. The model attributed 96% of illnesses from contaminated dairy products to unpasteurized products and estimated 840 times more illnesses (95% CrI 611-1,158) and 45 times more hospitalizations (95% CrI 34-59) than pasteurized products. These are modeled dairy estimates, not pregnancy-specific estimates and not estimates for juice. CDC says H5N1 was detected in raw milk from clinically ill and asymptomatic dairy cattle, but human infection from drinking contaminated raw milk remained unknown; CDC says pasteurization kills H5N1.

Breastfeeding

FDA and CDC discuss illness after direct consumption of raw milk, and their pages do not give separate breastfeeding instructions or address transmission through human milk. FoodSafety.gov gives pregnancy-specific and general food-safety guidance but no breastfeeding-specific recommendation for these foods. This entry describes direct food exposure and makes no claim about milk transfer.

What was tested

Costard et al. modeled U.S. outbreak reports from 2009-2014 for cow's milk and cheese and four pathogens: Campylobacter, Salmonella, Shiga toxin-producing E. coli, and Listeria. The analysis used 87 outbreaks, 750 laboratory-confirmed illnesses, and 215 hospitalizations and adjusted estimates for underreporting, under-testing, and underdiagnosis. It did not study juice or pregnancy-specific outcomes. Besser et al. investigated a 1991 Massachusetts E. coli O157:H7 outbreak with 18 patients and 49 controls and also tested pathogen survival in cider; the findings concern one unpasteurized cider mill, not all juice products. Linnan et al. investigated a 1985 California Listeria outbreak and implicated a brand of Mexican-style soft cheese; the study did not measure risk from a single serving of plain raw milk.