If you are pregnant and are craving for feta cheese, then this article is for you. Feta cheese is one of the most important Mediterranean food products (Katsouri et al., 2020). However, it is not entirely without dangers when consumed during pregnancy.
Feta cheese can be considered safe for consumption by pregnant women as long as it was made with pasteurized milk. Whether made from pasteurized or raw milk, it can also be made safe by properly cooking until steaming hot. Otherwise, feta cheese that is made from unpasteurized milk should be avoided by pregnant women due to the risk of infection with Listeria monocytogenes.Jesmarie Macapagal, RN, MD, DPPS
What is Feta Cheese?
Katsouri et al. (2020) made an extensive description of feta cheese. It mentioned that feta cheese has been given a protected designation of origin (PDO) from the European Union (EU) since 2002. As a PDO product, it must comply with specifications according to EU legislation related to its name, raw materials, production methods, geographical region of origin and production, inspection structures, and labeling details.
Feta PDO cheese can only be produced from sheep’s milk or from a mixture of sheep’s milk with up to 30% goat’s milk. Production sites are in particular areas of Greece, including Macedonia, Thrace, Epirus, Thessaly, mainland Greece, Peloponnesus, Lesvos, Limnos, and Agios Efstratios (Katsouri et al., 2020).
The majority of the feta cheese produced is made from pasteurized milk with the use of commercial lactic acid cultures (Katsouri et al., 2020). However, the PDO does not designate the use of pasteurized milk, hence raw milk can also be used by some feta cheese manufacturers.
Feta cheese is made by acidifying milk through the addition of yogurt starter cultures containing Streptococcus thermophilus and Lactobacillus delbrueckii subspecies bulgaricus. The resulting cheese is dry salted for 4 to 5 days, after which it is placed in brine containing about 8 percent salt content, and ripened for at least 60 days (Katsouri et al., 2020).
Traditionally, feta cheese is distributed in metal vessels or wooden barrels to be sold through the retailers’ service counters. Currently, however, pre-packed feta cheese products are being sold at supermarkets both in Greece and internationally (Katsouri et al., 2020).
Cheesemakers in the United States are now able to produce a “feta-style” cheese by making use of cow’s milk. Other countries also produce their own forms of feta cheese, including Australia, Denmark and Germany. Quality can vary from these so-called “Greek-style” or “salad cheese”.
Feta cheese is often used in salads and as an alternative to shredded mozzarella cheese for making pizzas and on flatbreads. It can also be sprinkled on top of any kind of roasted vegetables.
It can be served raw as an appetizer alongside slices of crusty baguette, olives and sliced meats. For cooked dishes, feta cheese is often added to baked casseroles, pastries and stews, and are also used for stuffed burgers.
Nutrient Composition of Feta Cheese
According to NutritionData, 1 ounce (or 28 grams) of feta cheese provides the following:
|Nutrient||Amount||Percent Daily Value|
|Vitamin A||118 IU||2%|
|Vitamin B6||0.1 mg||6%|
|Vitamin B12||0.5 mcg||8%|
This applies to all “feta-style” cheeses sold outside of Greece. In comparison to hard cheeses, feta cheese contains less calories and fat. While feta cheese contains only 74 calories and 6 grams of fat per 1 ounce, the same amount of parmesan and cheddar cheese contains 110 calories and 7.2 grams of fat, and 113 calories and 9.3 grams of fat, respectively.
In 2020, Katsouri et al. investigated the nutritional content of 81 pre-packed feta PDO cheese products from the Greek market. It reported that the range of nutrient contents per 100 grams are as follows:
- Energy – 221 to 343 kcal
- Total fat – 20 to 29 grams
- Saturated fat – 12.8 to 20.3 grams
- Carbohydrates – 0 to 3.1 grams
- Proteins – 13.1 to 21 grams
- Sodium – 1.2 to 5.1 grams
Risks Associated with Consumption of Feta Cheese During Pregnancy
The primary risk of eating soft cheeses like feta cheese is the possibility of acquiring Listeria monocytogenes infection. L. monocytogenes causes the severe food borne infection called listeriosis (Heiman et al., 2016). It is able to contaminate various foods and beverages (De Valk et al., 2005), and can multiply at refrigerator temperatures (Herrador et al., 2019).
Transmission to humans occurs primarily through consumption of contaminated food, most notably fish, meat products and cheese (EFSA Panel on BIOHAZ et al., 2018). Cheese-associated food borne illnesses have been mainly attributed to the consumption of soft cheeses (Choi et al., 2016).
Soft cheeses favor the growth of L. monocytogenes due to their relatively high moisture content. In addition, unpasteurized milk used for production of soft cheeses may become contaminated because cows, sheep and goats can shed the bacterium in their milk during lactation (Heiman et al., 2016).
According to the US FDA and Health Canada, soft cheeses that were made with unpasteurized milk are 50 to 160 times more likely to cause listeriosis per serving, compared to those made with pasteurized milk. However, even when pasteurized milk is used, contamination with L. monocytogenes can still occur during and after the cheese-making process if there are poor sanitary conditions (Heiman et al., 2016).
Silk et al. (2013) reported a total of 1,651 cases of listeriosis from 2009 to 2011 in the United States. Case fatality rate was 21 percent. Listeriosis is among the food borne illnesses with the highest case fatality rates. When this infection reaches the CNS, the mortality rate increases above 50 percent, and neurological sequelae are seen in more than 60 percent of those who survive (De Valk et al., 2005).
Compared with the general population, incidence of listeriosis was significantly higher among adults aged 65 years and older (58 percent) and pregnant women (14 percent) (Silk et al., 2013). Similarly, the invasive form of listeriosis occurs more commonly among pregnant women, neonates, the elderly and those with immunocompromising conditions (Herrador et al., 2019).
Listeriosis typically manifests as a nonspecific febrile illness in pregnant women. However, it can also result in fetal death, premature delivery, neonatal sepsis and meningitis (Heiman et al., 2016), and neonatal death (Herrador et al., 2019).
High Salt Content
A diet high in salt plays an important role in the development of arterial hypertension and promotes vascular, myocardial and renal fibroses (Appel et al., 2011). High dietary salt also causes endothelial dysfunction of the peripheral and cerebral arteries, leading to cerebral hypoperfusion, which is the main cause of ischemic stroke. Even a short-term increase in dietary salt triggers changes that could lead to development of autoimmune diseases (Schmidt-Pogoda et al., 2018).
Feta cheese is a food product with high sodium concentration (Katsouri et al., 2020). During the process of cheese-making, salt is added to the curd. In addition, the resulting cheese block is submerged in a brine of up to 8 percent salt.
The finished product is a cheese that has a sodium concentration of 312 milligrams for each serving of 1 ounce, which accounts for already 13 percent of the recommended dietary intake for sodium in adults.
Consuming Feta Cheese Safely During Pregnancy
The Centers for Disease Control and Prevention (CDC) categorized soft cheeses made using raw milk, such as feta cheese, queso fresco, blue veined and Camembert cheeses, into a high-risk group for consumption during pregnancy (Choi et al., 2016).
Therefore, both the US Food and Drug Administration (FDA) and the CDC recommend pregnant women to avoid eating soft cheeses, including feta cheese, unless it is clear on the label that pasteurized milk was used. The NHS agrees and mentions that pasteurized soft cheeses like feta cheese can be eaten during pregnancy.
Cooking can kill any potential Listeria. Therefore, cooking feta cheese, whether it was made from pasteurized or unpasteurized milk, will eliminate the risk of an infection if the temperature reaches 165 degrees Fahrenheit (or 75 degrees Celsius). For this matter, baked feta is an excellent choice for consumption during pregnancy.
When eating out in a restaurant, pregnant women must be careful about ordering meals with feta cheese. Although most restaurants would probably use pasteurized milk, there is still a chance that some local deli or Greek restaurant may use feta cheese made with unpasteurized milk. Ask the server or cook to confirm. When in doubt, order another safer dish.
Lastly, due to its high sodium concentration, pregnant women must remember to consume feta cheese only in moderation.
Feta cheese, whether the PDO or feta-style kind, can be made using either pasteurized or raw milk. Therefore, pregnant women should always check the label and consume only those that used pasteurized milk.
Another way to ensure safety of feta cheese is through cooking because this will kill any potential Listeria contamination. Feta cheese contains lower calories and fats compared to hard cheeses. However, it has a high sodium concentration and should be consumed only in moderate amounts.
Consulting a health care specialist or dietitian is the best way to ensure the safety of different types of food that can be consumed during pregnancy.