Can I eat medium rare steak while pregnant?

The verdict

It depends entirely on which country's guidance you are following, and the gap is wider here than for almost any other food.

The NHS lists whole cuts of beef and lamb, such as steaks or cutlets, that have been thoroughly cooked on the outside among the meats that are safe to eat in pregnancy. The Food Standards Agency explains the reasoning: whole cuts of meat, such as steaks and joints, other than poultry and pork, only ever have bacteria on the outside surface of the meat, and these can be served pink in the middle according to taste, provided you sear the meat at a high temperature to kill any bacteria on the outside and check that the outside has changed colour.

The FDA takes a different line. Its guidance for pregnancy is to cook beef, pork, veal and lamb roasts, steaks and chops to at least 145F, which is 63C, with a three minute rest time. That is a medium steak, not a medium rare one. ACOG's instruction is to avoid all raw and undercooked meat while pregnant and to use a food thermometer to check meat is at a safe temperature.

Ireland's HSE lists raw or under-cooked meat among foods to avoid. FSANZ lists raw and semi-cooked meat in its higher-risk table with thoroughly cooked meat as the safer alternative.

So: a pink steak is explicitly permitted in the UK and explicitly not in the US, Ireland, Australia or New Zealand.

The reasoning behind the British position

The UK argument turns on where the bacteria are.

A whole muscle from a healthy animal is essentially sterile inside. Contamination happens at slaughter and butchery, and it lands on the cut surfaces. As long as the piece has not been minced, skewered, needled, rolled or tenderised mechanically, whatever is on it is on the outside, and searing the outside at a high temperature destroys it.

That is why the FSA draws such a sharp line between whole cuts and everything else. Its guidance states that any meat that has been minced or skewered all the way through should be cooked thoroughly, because when a whole cut of meat is minced or skewered this moves any bacteria from the outside all the way through the meat. It names mincemeat of any type, burgers, sausages, kebabs, rolled joints, and kidney, liver and other offal, and says burgers should not be served rare or pink at home.

Poultry and pork are excluded from the pink-in-the-middle allowance entirely. The FSA states these can have bacteria all the way through the meat, so they need to be cooked all the way through.

Toxoplasma, and why it matters here

The NHS gives a pregnancy-specific reason for care with meat that has nothing to do with the surface-bacteria argument: there is a small risk of getting toxoplasmosis if you eat raw, undercooked or cured meat, which can cause miscarriage.

Toxoplasma gondii forms tissue cysts inside muscle, not on the surface, which is a genuine argument against the searing logic. UK guidance holds the line on whole cuts anyway, on the basis that the overall risk is low and that toxoplasma in British meat is uncommon. The NHS lists toxoplasmosis symptoms and advises getting help from 111 if you have them.

If you want to eliminate the toxoplasma question rather than accept a small risk, cooking to 70C for two minutes, which is the FSA's fully cooked standard, does it. That is a medium to medium well steak.

The numbers, side by side

The FSA's fully cooked standard is that the middle of the food should reach 70C for two minutes, or an equivalent combination: 60C for 45 minutes, 65C for 10 minutes, 70C for 2 minutes, 75C for 30 seconds, or 80C for 6 seconds. Those combinations all deliver the same lethality.

The FDA's number for whole cuts of beef, pork, veal and lamb is 145F, or 63C, with a three minute rest, which is close to the FSA's 65C for 10 minutes once carry-over cooking during the rest is taken into account. For ground beef, veal, lamb and pork the FDA requires 160F, or 71C; for all poultry, 165F, or 74C.

In steak terms, roughly: blue and rare are below any of these thresholds; medium rare sits around 55C to 57C, below all of them; medium is around 63C, which is the FDA number; medium well is around 68C to 70C, which is the FSA's fully cooked standard.

A steak cannot be checked by colour reliably. If you want to follow either standard precisely, a probe thermometer inserted into the thickest part is the only way to know.

Steak tartare, carpaccio and rolled joints

Steak tartare is raw minced beef, and mincing is precisely the process that moves surface bacteria through the meat. It is out under every guideline here, including the UK's.

Carpaccio is raw whole-muscle beef, sliced thin. It has not been seared, so it does not meet even the British condition of being thoroughly cooked on the outside. It is also often a chilled ready-to-eat food, which adds a listeria consideration. Avoid it.

Rolled joints are named by the FSA among meats that must be cooked all the way through, because rolling puts what was an outside surface into the middle. The NHS says the same: rolled joints of meat must be thoroughly cooked all the way through.

Meat that has been mechanically tenderised or needle-injected, sometimes labelled as such in North America, is in the same category, because the needles carry surface bacteria inward.

Eating out

Restaurants in the UK are permitted to serve steak pink, and many will ask how you want it. If you order medium rare you will get what the FSA permits.

Two practical points. First, ask for the steak to be seared properly rather than flash-grilled, particularly if it is thin. Second, be careful with a steak that arrives sliced and fanned out on the plate; slicing after cooking with a clean knife is fine, but it is worth being sure the board and knife were clean, since the FSA's cross-contamination advice exists for exactly this.

If you are pregnant and eating in the US, restaurants generally cook to order too, and the same choice is available. It is the published guidance that differs, not the kitchen.

If you have already eaten a rare steak

In the UK this is within guidance and there is nothing to do.

Elsewhere, a rare steak once is a small risk. Toxoplasmosis frequently causes no symptoms, and where it does they are flu-like: mild fever, aching, swollen glands and tiredness. The NHS advises getting help from 111 if you feel unwell after having food that should be avoided in pregnancy, if vomiting and diarrhoea last more than 48 hours, or if you have symptoms of listeriosis or toxoplasmosis.

If you are worried about a specific meal, say so at your next appointment. Testing for toxoplasmosis exists and is arranged through your maternity team, and it is a reasonable thing to ask about rather than to sit with.

Where guidance genuinely differs

The UK permits pink whole cuts on a mechanistic argument about where bacteria live. The US, Ireland, Australia and New Zealand set a cooked standard and do not carve out whole muscle.

All four agree completely on the rest: mince, burgers, sausages, kebabs, rolled joints and offal must be cooked through, and poultry and pork must be cooked through. Those points are not in dispute anywhere.

If you want to be inside every published guideline at once, order your steak medium and let it rest. If you are in the UK and want it medium rare, that is what your own national food safety agency says you may have.