Can I Eat Cold Pepperoni While Pregnant?

No, you should not eat cold pepperoni while pregnant. Cold, ready-to-eat pepperoni—such as sliced sticks, deli-counter slices, or pieces from a charcuterie board—can harbor harmful bacteria like Listeria and parasites that cause toxoplasmosis. To make pepperoni safe during pregnancy, it must be heated until steaming hot (165°F / 74°C) right before eating. This applies to all forms of cold pepperoni, including pre-packaged slices and those from a deli counter.

Why Cold Pepperoni Is Risky During Pregnancy

Pepperoni is a cured, fermented sausage that is not cooked during production. The fermentation and drying process lowers the pH, which inhibits many bacteria, but it does not eliminate all pathogens. Listeria monocytogenes, in particular, can survive in these conditions and even grow at refrigerator temperatures. During pregnancy, your immune system is suppressed, making you 10 to 20 times more susceptible to listeriosis, which can lead to miscarriage, stillbirth, or severe infection in the newborn. The NHS advises that cold cured meats like pepperoni should be cooked until steaming hot before eating to reduce this risk.

Additionally, cold cured meats may contain the parasite Toxoplasma gondii, which causes toxoplasmosis. This infection can also cause miscarriage or birth defects. Cooking meat thoroughly kills the parasite, making heated pepperoni safer.

How Heating Makes Pepperoni Safe

Heating pepperoni to an internal temperature of 165°F (74°C)—until it is steaming hot—kills Listeria and other pathogens. This is why pepperoni on a freshly baked pizza is generally considered safe: the high oven temperatures ensure the meat reaches the necessary heat. However, if the pizza has cooled or the pepperoni is not steaming, it should be reheated before eating. Leftover pizza should be reheated in an oven or air fryer until the pepperoni sizzles; a quick microwave zap may leave cold spots where bacteria survive.

For other dishes, such as sandwiches or pasta, ensure the pepperoni is heated thoroughly. You can pan-fry, bake, or microwave it until steaming. Avoid eating cold pepperoni straight from the package or deli counter.

Specific Risks: Listeria and Toxoplasmosis

Listeriosis: Caused by Listeria monocytogenes, this infection is particularly dangerous during pregnancy. It can cross the placenta and infect the baby, leading to miscarriage, stillbirth, premature delivery, or life-threatening illness in the newborn. Symptoms in the mother may be mild (fever, muscle aches, gastrointestinal issues), but the consequences for the baby can be severe. Because Listeria can grow at refrigeration temperatures, cold deli meats are a known risk. The CDC advises pregnant women to avoid ready-to-eat meats or reheat them to 165°F.

Toxoplasmosis: This infection is caused by the parasite Toxoplasma gondii, which can be present in raw or undercooked meat, including cured meats. Infection during pregnancy can cause miscarriage, stillbirth, or congenital disabilities. Cooking meat to a safe temperature kills the parasite. The NHS notes that cold cured meats may contain parasites that cause toxoplasmosis unless cooked thoroughly.

What About Pepperoni on Pizza?

Pepperoni on a pizza that is served hot and steaming is safe to eat during pregnancy. The high heat of the oven kills harmful bacteria. However, if the pizza has been sitting out and is no longer hot, or if you are eating leftover pizza cold, the pepperoni should be reheated until steaming. Follow the two-hour rule: discard any perishable food left at room temperature for more than two hours (or one hour if the temperature is above 90°F).

Other Considerations: Sodium and Nitrates

Even when heated, pepperoni is high in sodium and saturated fat. Excessive sodium intake can contribute to high blood pressure and swelling (edema) during pregnancy. The U.S. Dietary Guidelines recommend limiting sodium to less than 2,300 mg per day. Pepperoni also contains sodium nitrite, a preservative that gives it its red color and prevents botulism. While nitrites are generally recognized as safe in regulated amounts, it's wise to consume processed meats in moderation during pregnancy. Balance higher-sodium foods with plenty of fruits, vegetables, and unsalted options.

Safe Ways to Enjoy Pepperoni While Pregnant

• Heat it thoroughly: Cook pepperoni until steaming hot (165°F) before eating. This can be on a pizza, in a hot sandwich, or added to a cooked dish.
• Reheat leftovers properly: If you have leftover pizza or a dish with pepperoni, reheat it in an oven or air fryer until the meat is sizzling. Avoid eating it cold.
• Avoid deli-counter slices: Deli slicers can harbor Listeria and cross-contaminate meats. If you buy sliced pepperoni from a deli, heat it before eating.
• Check labels: Some pepperoni products are labeled "ready-to-eat," but this does not mean they are safe without heating during pregnancy. Always heat to steaming.
• Practice good food safety: Keep cold foods refrigerated, wash hands and surfaces, and avoid leaving perishable foods out for extended periods.

When to Contact a Healthcare Provider

If you have eaten cold pepperoni and are concerned, monitor for symptoms such as fever, muscle aches, nausea, or diarrhea. Listeriosis symptoms can appear days or even weeks after exposure. Contact your healthcare provider if you experience any symptoms, especially if you are pregnant. Early treatment with antibiotics can reduce the risk to your baby. This information is general and not a substitute for individual medical advice.