Refrigerated Smoked Fish (Lox)
Everyday exposureFood & drinkAlso called · 8 names▾▴
lox, smoked salmon, nova lox, nova-style salmon, cold-smoked fish, kippered fish, refrigerated smoked fish, smoked fish
Listeria group
General information · effects depend on amount, timing, and how it is used. About these sources
Research strength: 3 / 5
FoodSafety.gov says pregnant people should not eat refrigerated smoked seafood unless it is in a cooked dish heated to 165°F (74°C); canned or shelf-stable fish is listed as an option. CDC lists refrigerated fish sold as lox or Nova-style and says cold-smoking and refrigeration do not kill Listeria. The NHS says cold-smoked or cured fish such as smoked salmon should be cooked until steaming hot. EFSA found Listeria in some ready-to-eat fish samples, but its retail survey did not measure illness or risk from a serving of lox. NHS guidance and prospective cohorts of confirmed maternal-neonatal listeriosis describe serious outcomes, not the risk from eating one product. Ask your provider about your situation.
Last reviewed: 2026-10-18
Sources
- FoodSafety.gov: People at Risk, Pregnant Women
- CDC: Preventing Listeria InfectionUS government
- CDC: How Listeria Spread: Pâté and Cold-Smoked FishUS government
- NHS: Foods to avoid in pregnancyUK government
- EFSA Journal: EU baseline survey of Listeria in ready-to-eat foodsEU agency
- Charlier et al. 2017: MONALISA prospective cohortUS government
- Charlier et al. 2022: Neonatal MONALISA prospective cohortUS government
Research strength: 3 / 5
FoodSafety.gov says pregnant people should not eat refrigerated smoked seafood unless it is in a cooked dish heated to 165°F (74°C); canned or shelf-stable fish is listed as an option. CDC lists refrigerated fish sold as lox or Nova-style and says cold-smoking and refrigeration do not kill Listeria. The NHS says cold-smoked or cured fish such as smoked salmon should be cooked until steaming hot. EFSA found Listeria in some ready-to-eat fish samples, but its retail survey did not measure illness or risk from a serving of lox. NHS guidance and prospective cohorts of confirmed maternal-neonatal listeriosis describe serious outcomes, not the risk from eating one product. Ask your provider about your situation.
Last reviewed: 2026-10-18
Sources
- FoodSafety.gov: People at Risk, Pregnant Women
- CDC: Preventing Listeria InfectionUS government
- CDC: How Listeria Spread: Pâté and Cold-Smoked FishUS government
- NHS: Foods to avoid in pregnancyUK government
- EFSA Journal: EU baseline survey of Listeria in ready-to-eat foodsEU agency
- Charlier et al. 2017: MONALISA prospective cohortUS government
- Charlier et al. 2022: Neonatal MONALISA prospective cohortUS government
Research strength: 3 / 5
FoodSafety.gov says pregnant people should not eat refrigerated smoked seafood unless it is in a cooked dish heated to 165°F (74°C); canned or shelf-stable fish is listed as an option. CDC lists refrigerated fish sold as lox or Nova-style and says cold-smoking and refrigeration do not kill Listeria. The NHS says cold-smoked or cured fish such as smoked salmon should be cooked until steaming hot. EFSA found Listeria in some ready-to-eat fish samples, but its retail survey did not measure illness or risk from a serving of lox. NHS guidance and prospective cohorts of confirmed maternal-neonatal listeriosis describe serious outcomes, not the risk from eating one product. Ask your provider about your situation.
Last reviewed: 2026-10-18
Sources
- FoodSafety.gov: People at Risk, Pregnant Women
- CDC: Preventing Listeria InfectionUS government
- CDC: How Listeria Spread: Pâté and Cold-Smoked FishUS government
- NHS: Foods to avoid in pregnancyUK government
- EFSA Journal: EU baseline survey of Listeria in ready-to-eat foodsEU agency
- Charlier et al. 2017: MONALISA prospective cohortUS government
- Charlier et al. 2022: Neonatal MONALISA prospective cohortUS government
Refrigerated Smoked Fish (Lox) — Breastfeeding
Research strength: 2 / 5
The NHS says breastfeeding does not require a special diet and includes fish among protein foods. Its cold-smoked and cured fish warning is in its pregnancy guidance, and CDC and FoodSafety.gov give smoked-fish cautions for pregnancy or other higher-risk groups. These pages do not give a separate lox limit for breastfeeding or assess contaminated lox during lactation. Ask your provider about your situation.
Last reviewed: 2026-10-18
Sources
- NHS: What to eat and drink when breastfeedingUK government
- NHS: Foods to avoid in pregnancyUK government
- CDC: Preventing Listeria InfectionUS government
- FoodSafety.gov: People at Risk, Pregnant Women
Pregnancy
The 2018 systematic review by Moran et al. included 11 case-control or cross-sectional studies. One Iranian cross-sectional paper in the review compared smoked seafood reports in 317 women with spontaneous abortion, including 54 whose vaginal swabs were PCR-positive for Listeria; the review rated the study poor quality. The design does not compare pregnant people who ate lox with an unexposed group and cannot show that smoked seafood caused pregnancy loss. A French prospective MONALISA cohort of 107 confirmed maternal-neonatal infections reported fetal loss in 26 mothers, and a later cohort of 189 liveborn infants with confirmed maternal-neonatal listeriosis reported 17 infants with major adverse outcomes. These are outcomes among confirmed infections, not probabilities for lox consumers. EFSA's 2010-2011 retail survey examined 13,088 ready-to-eat foods, including 3,053 batches of smoked or gravad fish; by end of shelf life, Listeria was found in 10.3% of fish samples and 1.7% of fish samples exceeded 100 CFU/g. The fish group included smoked and gravad styles, and those data do not estimate illness risk per serving or risk specifically from lox. The NHS also states that listeriosis in pregnancy can cause miscarriage or stillbirth or make a newborn seriously ill.
Breastfeeding
Targeted PubMed searches for Listeria, smoked fish, lox, breastfeeding, and lactation found no direct study of refrigerated lox during breastfeeding. The NHS breastfeeding page says a special diet is not needed and includes fish, but it does not discuss Listeria in smoked fish. CDC and FoodSafety.gov give their smoked-fish cautions in pregnancy guidance or for other groups at higher risk, not as a separate breastfeeding rule. This absence of a specific rule does not evaluate contaminated product exposure during lactation.
Refrigerated smoked fish is a ready-to-eat food category that includes products labeled lox, Nova-style, kippered, smoked, or jerky. It is different from canned or shelf-stable smoked fish. CDC says cold-smoked fish can become contaminated during processing, and that cold-smoking and refrigeration do not kill Listeria.
What was tested
Moran et al. summarized 11 case-control or cross-sectional studies; food-exposure reports were usually retrospective. Pourkaveh et al. used vaginal-swab PCR and questionnaires in 317 women with spontaneous abortion; the study did not test lox servings or establish causation. EFSA tested retail ready-to-eat food samples for Listeria presence and counts, not pregnant people or illness after a serving. The MONALISA cohorts described outcomes among confirmed maternal-neonatal infections, not outcomes from eating a specific fish product.
We found no disagreement between the sources checked.
- FoodSafety.gov lists refrigerated smoked seafood only in a cooked dish heated to 165°F (74°C), or canned or shelf-stable smoked fish, as options during pregnancy. (FoodSafety.gov)
- The NHS says cold-smoked or cured fish, such as smoked salmon, should be cooked until steaming hot during pregnancy. (NHS)
- CDC says cold-smoking and refrigeration do not kill Listeria; it lists heat-treated shelf-stable smoked fish or cooked smoked fish as alternatives. (CDC)
General research, not specific to pregnancy.
CDC identifies adults 65 or older and people with weakened immune systems as groups at higher risk for serious Listeria infection.
- CDC lists refrigerated smoked fish for these higher-risk groups and lists sealed shelf-stable fish or smoked fish cooked in a dish as alternatives. (CDC: Preventing Listeria Infection)
Experiences from moms and non-medical voices. Not medical evidence.
- CDC: Preventing Listeria InfectionUS governmentSecondaryPage dated 2025-01-31
- FoodSafety.gov: People at Risk, Pregnant WomenSecondaryPage dated 2026-10-05
- NHS: Foods to avoid in pregnancyUK governmentSecondaryPage dated 2026-06-15Independent check
- CDC: How Listeria Spread: Pâté and Cold-Smoked FishUS governmentSecondaryPage dated 2024-08-11
- Moran et al. 2018: Nutrition and listeriosis during pregnancy, systematic reviewUS governmentPrimary
- Pourkaveh et al. 2016: Factors contributing to spontaneous abortion caused by Listeria monocytogenesUS governmentPrimary
- EFSA Journal: EU baseline survey of Listeria in ready-to-eat foodsEU agencyPrimaryPage dated 2013-06-27Independent check
- Charlier et al. 2017: MONALISA national prospective cohortUS governmentPrimaryIndependent check
- Charlier et al. 2022: Neonatal Listeriosis Presentation and OutcomeUS governmentPrimaryIndependent check
- NHS: What to eat and drink when breastfeedingUK governmentSecondaryIndependent check
Last reviewed 2026-10-18
Independent check 2026-10-18
Not yet clinician-reviewed
Ask your provider about your situation.