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Premium member Presentation Transcript Physical & psychosocial adaptation to Pregnancy: Physical & psychosocial adaptation to Pregnancy“ I’m Pregnant!!”: “ I’m Pregnant!!” Menses is 5 days late + UPT: urine preg test Presumptive, Probable, or Positive sign?Presumptive Indicators (least reliable): Presumptive Indicators (least reliable) Sign Other Possible Causes Amennorhea Nausea & vomiting Fatigue Urinary frequency Breast & skin changes Cervical color changes (Chadwick’s sign) Emotional stress, strenuous exercise, endocrine problems, chronic disease, early menopause, low body weight GI virus, food poisoning, emotional stress UTI Premenstrual changes, OCPs InfectionProbable Indicators: Probable Indicators Sign Other Possible Causes Abdominal Enlargement Cervical softening ( Goodell’s sign) Softening of lower uterine segment ( Hegar’s sign) Abdominal or uterine tumors, wt. gain OCPs or hormonal imbalanceProbable Indicators: Intestinal gas Fibroids Maternal pulse Some medications, hematuria , production of Hcg by malignant tumors Ballottement Braxton Hicks UCs Palpation of fetal outline Uterine soufflé + Pregnancy tests Probable Indicators Signs Possible Other CausesPositive Indications: Positive Indications Auscultation of FHTs -- Doppler ultrasound Fetal movements felt by examiner Visualization of embryo or fetusAntepartum Care: OB History: Antepartum Care: OB History Gravida : Is or has been pregnant Para: # of pregnancies > 20 weeks Not number of babies G ravida T erm P remature A bortions L iving Dana has delivered 2 babies at 38 and 39 weeks gestation, both are living. Megan has delivered 3 babies at 39-40 weeks gestation and one 12 week spontaneous abortion, 3 living children This is Joy’s first pregnancy Stephanie has delivered twins at 35 weeks gestation, another baby at 38 weeks gestation and has had 2 spontaneous abortions, 3 children are living.What is my due date?: What is my due date? Menstrual history First day of last normal period (LNMP) Regular cycles? Hormonal BC? Pregnancy duration 40 wks or 280 days from LNMP Nagele’s rule: LNMP – 3 months + 7 days Pregnancy calculator US: correct + 5-7days up to 12 wks gestationEDC or EDD: EDC or EDD EDC = E stimated D ate of C onfinement EDD = E stimate D ue D ate Using Nagel’s rule: LNMP: September 3 rd Subtract 3 months Add 7 days EDC = ?Antepartum Care: Risk Assessment: Antepartum Care: Risk Assessment Demographic Factors Age < 16 yrs or > 35: Preterm birth, preeclampsia, congenital anomalies Race African American: Preterm birth, low-birth weight, infant & maternal death Socioeconomic status Low: Preterm birth, low-birth weight Parity > 4 pregnancies: Pregnancy loss, postpartum hemorrhage, c/sAntepartum Care: Risk Assessment: Antepartum Care: Risk Assessment Behavioral Lifestyle Factors Prepregnancy weight Underweight: low birth weight births Obese: preeclampsia, GDM, C/S, wound infections,endometritis , thromboembolism Height < 5 ft.: C/S Smoking: spontaneous AB, placenta abruption, placenta previa , low birth weight, preterm birth, SIDS ETOH: mental retardation, fetal alcohol syndrome Street drugs: Congenital anomalies, neonatal withdrawal syndromeAntepartum Care: Risk Assessment: Antepartum Care: Risk Assessment Obstetric Factors Previous infant > 4,000 g (8 lbs 14 oz) risk GDM, infant birth injury, c/s, neonatal hypoglycemia (baby is cut off from source of glucose … the mom) Previous stillbirth or neonatal death Maternal psychological distress RH negative Rh sensitization Previous Preterm birth risk repeated PTBAntepartum Care: Risk Assessment: Antepartum Care: Risk Assessment Medical Conditions DM preeclampsia, SGA or LGA, neonatal hypoglycemia, congential anomalies, fetal or neonatal death Hypothyroidism SAB, congenital hypothyroidism Hyperthyroidism Preeclampsia, thyroid storm, neonatal risk for thrytoxicosis Cardiac Disease Maternal risk cardiac decompensation & death Renal Disease Maternal renal failure, PTB, Intrauterine growth retardation Concurrent infections Dependent upon the infectious agent and trimester of occurrenceTrimesters of Pregnancy: Trimesters of Pregnancy 1 st trimester Up to 12 weeks 2 nd trimester 13 weeks – 27 weeks 3 rd trimester – 28 weeks to deliveryPhysiologic Changes of Pregnancy: Physiologic Changes of PregnancyPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Placental Hormones Human Chorionic Gonadotropin hCG Trophoblastic cells produce Maintains corpus luteum Estrogen & progesterone 10-12 wks gestation + UPT or serum pregnancy testPhysiologic Changes of Pregnancy Placental Hormones: Physiologic Changes of Pregnancy Placental Hormones Estrogen Functions Progesterone Functions Stimulates uterine growth vascularization Breast changes Skin hyperpigmentation salivary glands- pytalism Hyperemia of gums & nasal mucous membranes Maintain endometrium Relax smooth muscles Uterine GI Bladder & ureters Breast changes Maternal fat stores Sensitivity to CO 2 Immune systemPhysiologic Changes of Pregnancy Placental Hormones: Physiologic Changes of Pregnancy Placental Hormones Human Placental Lactogen hPL Increases steadily fetal glucose availability Insulin antagonist maternal glucose metabolism constant fetal glucose supply Relaxin Inhibits uterine activity softens connective tissue Cervix Pelvis LungsPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Reproductive System Uterus Growth 1 st trimester: Estrogen & growth factors stimulate 2 nd & 3 rd trimester: growing fetus Non-pregnant 50-70 g, capacity 10 mL Term: 800-1200 g, capacity 5000 mLPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Pattern of growth Predictable 12 wks: above symphysis pubis 20 wks: fundus @ U After 20 wks fundal ht. weeks gestation = centimeters Braxton-Hicks contractions Freq increases with uterine growth Consistent character Uterine blood flow 3 rd trimester: 750 mL/minPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Cervix Estrogen Chadwick’s sign: Congested with blood bluish color Goodell’s sign: softening Mucus plug forms: stops bacteria Vagina & vulva bluish color - vascularity Softening Leukorrhea: thick, white discharge Glycogen Lactobacillus acidophilus Vaginal pH acidic (3.5-6)Physiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Ovaries Corpus luteum Secrets progesterone till 10 th – 12 th week Regresses once placenta takes overPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Breasts Estrogen Growth of mammary ductal tissue Progesterone Growth of lobes, lobules, & alveoli Vascular Nipples Larger, erect, darker Areola Larger, darker Montgomery tubercles Larger Lubricate nipples Colostrum 12-16 wksPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Endocrine System Pituitary Gland size Anterior pituitary Prolactin Milk production Insulin antagonist Melanocyte-stimulating hormone hyperpigmentation Posterior pituitary Oxytocin – stimulates UCs; helps to eject milk during let down reflex in breast feeding Oxytocin also increases calmness and relaxation post deliveryPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Endocrine System Thyroid Gland Slight enlargement Basal metabolic rate by 25% Fetal metabolic activity Thyroid hormones: T 3 & T 4 Cross-over placenta Development of fetal CNS No thyroid hormones until 12 weeks gestationPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Endocrine System Pancreas Responsive to changes in maternal glucose changes 1 st trimester 10% - 20% in pre-pregnancy glucose levels 2 nd trimester Insulin sensitivity in response to hPL , prolactin , estrogen, progesterone, & cortisol Insulin production in healthy pancreasPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Cardiovascular System HR 15-20 bpm + blood volume = cardiac output vasodilation decreased periperal vascular resistance BP Greatest @ 24-32 wks – nrml @ term Lowest in lateral position Higher sittingPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Cardiovascular System Supine hypotension syndrome 2 nd & 3 rd trimester Heavy gravid uterus compresses vena cava reduces cardiac return BP Lightheadedness, dizziness, nausea, clammy, agitationPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Cardiovascular System RBC 250-450 mL Physiologic anemia Plasma volume > RBC Dilution of RBCs Not true anemia Greatest @ 28 wks Protective effect - blood viscosity - blood clotsPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Respiratory System O 2 Consumption Rises 20% - 40% Progesterone Mild hyperventilation – deeper breaths Increase tidal volume Airway resistance Relaxed smooth muscle Respiratory center sensitivity c/o SOB or “air hunger” Estrogen vascularity Congestion Nose-bleeds Ears full or earachesPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Respiratory Physical Changes Relaxin Chest expands 2 -2.25 in. (5-7cm) Enlarged uterus Lifts diaphragm 1.6 in. (4 cm) Breathing thoracic vs abdominal 75% experience SOB 3 rd trimester -- Raising hands over head increases tidal spacePhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy GI System Nausea & Vomiting Resolved 12-13 wks Mouth Estrogen Hyperemia red, swollen, gums bleed easily Ptyalism Esophagus & Stomach Progesterone Esophageal sphincter relaxed: reflux Gastric acidity 3 rd trimesterPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy GI System Large & Small Intestines Progesterone: relaxes smooth muscle Slower emptying absorption of nutrients bloating,constipation , gas Liver & GB Estrogen: hemodilution Serum alkaline phosphatase Serum albumin & total protein Progesterone Prolonged emptying time Risk for Gallstones Bile salts intense, generalized itchingPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Urinary System Bladder Progesterone Relaxes Urinary incontinence: 30%-50% Physical compression 1 st & 3 rd trimester Frequency Nocturia Kidneys & UreterPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Urinary System Kidney & Ureters Changes in size & shape Progesterone & physical compression Dilation of renal pelves , calyces, & ureters Ureters partially obstructed dilation esp. on right side Urine stasis: risk UTI Functional changes renal blood flow 50%-80% Glucose excretion glycosuriaPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Integumentary System Skin circulation & metabolism “hot” perspiration acne Hyperpigmentation 91% of women Estrogen, progesterone, & melanocyte -stimulating hormone Dark complexion > light complexion “mask of pregnancy” chloasma Linea nigraPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Integumentary System Connective Tissue “Stretch marks” Striae gravidarum Linear tears in connective tissue Abdomen, breasts, & buttocks Slightly depressed, purple – pink streaks Permanent but change to silvery white color Hair & Nails Grows more rapidly After delivery: rapid hair loss resolves by 6-12 months post partum.Physiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Musculoskeletal System Relaxin & progesterone Gradual softening of pelvic cartilage & connective tissue Relaxed sacroiliac joints & symphysis pubis “waddling” gait of pregnancy Lordosis of spine Separation of rectus abdominis muscles Diastasis rectiPhysiologic Changes of Pregnancy: Physiologic Changes of Pregnancy Immune System Fetus foreign tissue Immunological balancing act Protect mom from infection Prevent rejection of fetus Placenta Separates maternal & fetal Blood & lymphatic systems Results Successful pregnancy Increased risk for maternal infections Improved auto-immune disorders Rheumatoid arthritis, lupusCommon Discomforts of Pregnancy: Common Discomforts of Pregnancy During Joy’s first OB visit @ 10 wks gestation she tells her provider: Nauseated most of day Vomits 1-3/day Fatigued Urinary frequency Symptoms Cause? Differential Diagnosis? Comfort Measures?Common Discomforts of Pregnancy: Common Discomforts of Pregnancy During Joy’s 24 week visit she tells her provider that she has noticed: Several skin changes Her nipples are darker and there are “bumps” in the aerola She has a dark line in the center of her abdomen She is feeling nasal congestion, had a nose bleed, and snores at night She feels SOB and sometimes lightheaded She gets a pain in her right side. Symptoms Cause? Differential Diagnosis? Comfort Measures?Round Ligament: Round LigamentCommon Discomforts of Pregnancy: Common Discomforts of Pregnancy During Joy’s 37 th week visit she asks her provider: What can she do to improve her backache/ Her vaginal discharge has increased – could she have an infection? What can she do for the swelling in her legs & feet? Symptoms Cause? Differential Diagnosis? Comfort Measures?Postural Changes & Backache: Postural Changes & BackacheMaternal Psychosocial Pregnancy Adaptations: Maternal Psychosocial Pregnancy Adaptations First Trimester – “ I am pregnant” Uncertainty Validation of pregnancy UPT Reaction Eager or dread Ambivalence 50% unintended “Someday but not now” Primary focus – Self Fetus vague and unreal Mood swingsMaternal Psychosocial Pregnancy Adaptations: Maternal Psychosocial Pregnancy Adaptations Second Trimester -“I am going to have a baby” Pregnancy becomes real Growing Uterus 20 week US Fetal movement Primary focus – Fetus Ist trimester “ yuckies ” gone Activity minimally affected by size Heighted interest in diet & fetal development information Narcissism & Introversion Concerned with ability to care & protect fetus Examine relationship with others Daydream about infantMaternal Psychosocial Pregnancy Adaptations: Maternal Psychosocial Pregnancy Adaptations Second Trimester – Body image Rapid changes Breasts, abdomen, pigmentation, etc Altered function Balance, physical endurance, & discomfort Viewed (-) or (+) Sexuality Changes Increase, same, decrease Cultural influence Freedom from worry about becoming pregnant Increased labial and clitoral sensitivity Creative positions Worry of harming fetus – especially menMaternal Psychosocial Pregnancy Adaptations: Maternal Psychosocial Pregnancy Adaptations Third Trimester – “I am going to be a mother” Vulnerability Nightmares Protecting baby at all times Increasing dependence Relies on others to assist with decisions Needs reassurance from partner Difficulty concentrating Preparation for birth feelings of separateness from fetus Anxiety over upcoming labor & birth Pregnancy discomfort – READY for labor!Steps in Maternal Role Taking: Steps in Maternal Role Taking Mimicry Trying on the pregnant & mothering role Observing & copying Role Play Acting out & Practice Sensitive to partner & mother’s response Fantasy Daydream, “try-on” Boy, girl, dark or light hair, blue eyes? Activities with infant – child Dreams The Search for Role Fit Examines expectations of acceptable behaviors Observes and compares other mothers Grief Work Loosing aspects of themselves Relinquish old patterns of behaviorMaternal Tasks of Pregnancy: Maternal Tasks of Pregnancy Seeking Safe Passage Securing Acceptance Learning to Give of Herself Committing Herself to the Unknown ChildMaternal Tasks of Pregnancy: Maternal Tasks of Pregnancy Securing Safe Passage Priority task Seeks health care Follows recommendations for: Diet Vitamins Avoidance of harmful food & substances Adheres to cultural practicesMaternal Tasks of Pregnancy: Maternal Tasks of Pregnancy Securing Acceptance Acceptance as a mother Partner Willingness to change exclusive relationship Reaction to pregnancy announcement Family members Woman’s mother Increased closeness Unconditional acceptance of infant Boy or girl? Physical anomaliesMaternal Tasks of Pregnancy: Maternal Tasks of Pregnancy Learning to Give of Herself Her body nurtures the growing fetus Acts of kindness to: Family Friends Making lifestyle changes to accommodate new baby Baby showers Confirm interest & commitment of family & friendsMaternal Tasks of Pregnancy: Maternal Tasks of Pregnancy Committing Herself to the Unknown Child 1 st trimester: accepts pregnancy 2 nd trimester: attachment Baby real, feelings of love Fetal movement Ultrasound images 3 rd trimester Describe unique characteristics of their baby Sleep-wake cycles, movements, communication Delayed attachment Pass critical time periodPaternal Pregnancy Adaptations: Paternal Pregnancy Adaptations Developmental Processes: Reality of pregnancy and child Ambivalence Reality boosters FHTs US Fetal movement Struggle for recognition as a parent Feelings often left unvalidated Childbirth classes – talk with other men Talk about roles Who feeds, changes diapers, night time care? Role of the involved father Reflections of self, “trying on” of behaviors Parenting information Couvade Pregnancy symptoms Following through on cultural rolesSibling Adaptation: Sibling Adaptation Toddlers < 2 yrs. Unaware of maternal changes Unaware new baby coming Normal for expression of jealousy, resentment, anger Helpful hints: Establish new sleeping arrangements several wks prior to birth Accept negative feelings & reassure of love & affectionSibling Adaptation: Sibling Adaptation Older Children 3 – 12 yrs Aware of maternal changes “look, feel, listen” Questions!! Disappointed newborn is not instant playmate Reassure sibling of importance Include in preparations Sibling classesSibling Adaptation: Sibling Adaptation Adolescents Depends on developmental level Immersed in own developmental tasks Embarrassed Confirms parents sexuality May be Indifferent Very involvedCultural Responses to Pregnancy: Cultural Responses to Pregnancy Nurse Ask No stereotyping Avoid violating cultural norms Common areas of conflict: Health Beliefs Hot – cold Wet – dry “evil eye” Communication Language & non-verbal barriers Interpreters Time orientation Missed appointmentsCultural Competency: Cultural Competency E xplanation: “What concerns do you have about labor?” T reatments: “What are your plans for pain relief?” H ealers: “Who else might help during labor?” N egotiate: Try to find mutually acceptable options I ntervention: Develop intervention strategies together C ollaboration: Collaborate with woman, family, community resourcesIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) Myths IPV is rare IPV only occurs in poor families IPV is easy to stop – leave, get a divorce IPV victims like abuse IPV victims are mentally ill If IPV victims were serious they would prosecute Facts 4.8 million IPV assults /yr Women 6 times more likely to be the victim IPV may start or in pregnancy Rates: whites > AA > Hispanic 20% of ED visits by womenIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) Factors that promote violence Value of women by culture Men hold power Women financially dependent Stereotypes regarding power self-esteem Less worthy Acceptance of violent behavior Deserving of abuse Substance abuse Escalates violenceIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) Characteristics of abuser Power Isolation Intimidation Threats Jealousy Possessiveness Control Hx of abuseIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) cycle of violenceIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) Nurses role Screening Ask questions Not in the presence of abuser Note cues Nonverbal – flat affect Injuries - document Vague somatic complaints- anxiety, panic attacks Discrepancy between history and types of injuries ListenIntimate Partner Violence (IPV): Intimate Partner Violence (IPV) Assist in developing a personal safety plan Escape routes Safe place for key documents, keys, set of cloths Code word with trusted friend Affirm she is not to blame Violence is not normal Provide Education Avoid substance abuse Provide Referrals http://www.youtube.com/watch?v=bXWKCb8cFAIPregnancy Nutritional Needs: Pregnancy Nutritional Needs Inadequate or excessive nutrition Poor maternal & perinatal outcomes Intrauterine environment sets the stage for future risk of: Obesity Metabolic syndrome T2DM CVDPregnancy Nutritional Needs: Pregnancy Nutritional Needs Total Wt. gain recommendations Based on BMI Wt/Ht2 1st trimester 1-4.4 lbs Wt before pregnancy Total Gain Average wkly gain 2 nd & 3 rd trimester Underweight (BMI < 18.5) 28-40 lb 1 lb/wk Normal weight (BMI 18.5 -24.9) 25-35 lb 1 lb/wk Overweight. (BMI 25-29.9) 15-25 lb 0.6 lb/wk Obese (BMI > 30) 11-20 lb 0.5 lb/wkDistribution of Weight Gain During Pregnancy: Distribution of Weight Gain During Pregnancy Maternal reserves (fat & protein) 4 - 9.5 lbs Tissue Fluids 3.5 – 5 lbs Breasts 1.3- 3 lbs Fetus 7.5-8 lbs Uterus 2.5 lbs Amniotic Fluid 2 lbs Placenta 1 – 1.5 lbs Total Weight gain 25-35 lbsPregnancy Nutrient Needs: Pregnancy Nutrient Needs http://www.mypyramid.gov/mypyramidmoms/index.htmlPregnancy Nutrient Needs: Pregnancy Nutrient Needs Pregnancy caloric needs Depends on: age, activity level, & BMI 2,200 – 2,900 calories/day 1 st trimester: no increase in calories 2 nd trimester: 340 calories/day 3 rd trimester: 452 calories/day Achieved by a small increase in foodPregnancy Nutrient Needs: Pregnancy Nutrient Needs Grains Half from whole grains 7 servings/day Serving = 1 oz 1 slice bread 1 C cereal ½ C cooked rice, cereal, pastaPregnancy Nutrient Needs: Pregnancy Nutrient Needs Vegetables & Fruits Variety spice of life! 2.5 C = 5 ½ C servings of vegetables/day Serving = ½ C cooked broccoli, ½ C green beans, 1 C raw, leafy vegetables 2 C = 4 ½ C servings of fruits/day Serving = 1 apple, 1 orange, 1 banana 32 grapes, ½ C raisins (dried fruit)Pregnancy Nutrient Needs: Pregnancy Nutrient Needs Meat and Beans Meat, poultry, fish, eggs, legumes, nuts, & soybean products 7 oz/day 3 oz meat = deck of playing cards 1 oz = ¼ cup cooked dry beans, 1 egg, 1 T of peanut butter, or ½ ounce of nuts or seeds Choose lean meats, bake, grill, or broilPregnancy Nutrient Needs: Pregnancy Nutrient Needs Milk 3 servings/day Servings = 1 C Choose fat free or low fat 1 C milk or yogurt 1 ½ oz natural cheese 2 oz of processed cheesePregnancy Nutrient Needs: Pregnancy Nutrient Needs Unsaturated fats or oils Polyunsaturated fats contain some fatty acids that are necessary for health—called “essential fatty acids.” 2 servings/day Serving = 1 TCalorie Budget: Calorie Budget Essentials = rent & food Extras = movies & vacation Nutritional dense foods High nutrient density Low in calories High in nutrients Eat the lowest fat and no-sugar-added forms of foods in each food group Vegetables Fruits Whole grains Skim milk Low fat cheese, yogurt Empty calorie foods High in calories Low in nuttients Avoid higher calorie forms of foods contain solid fats or added sugars. whole milk, cheese, sausage, biscuits, sweetened cereal, and sweetened yogurt. Avoid adding fats or sweeteners to foods. sauces, salad dressings, sugar, syrup, and butter. Avoid food or drinks that are mostly fats or low nutrient density Soda, cookies, candy, donuts, ice cream, chipsFluid Intake: Fluid Intake Water 8-10 C/day Minimize or Avoid Juices Soft drinks Sweet Tea Coffee High in calories and low in nutrientsSupplements: Supplements Don’t replace a healthy diet PNV Folic acid > 600 mcg/day Iron 27 mg/day DHA Omega 3 & 6 Essential Fatty acidsFood Safety in Pregnancy: Food Safety in Pregnancy Listeriosis Listeria bacteria Symptoms Flu like symptoms 2,500/year Pregnancy complications SAB Premature birth Stillbirth Foods to avoid Hot dogs, luncheon meats (heat to steaming) Pate, meat spreads, smoked seafood Raw unpasteurized milk Store ham, chicken, egg, or tuna salad Soft unpasteurized cheese: feta, Brie, queso fresco or blanco . Blue-veinedFood Safety in Pregnancy: Food Safety in Pregnancy Mercury in Fish Harm developing nervous system Advice: Do not eat: Shark Swordfish King Mackerel Tilefish Fish High in Omega-3, 6 & DHA Important for neurological & vision development May eat 12 oz/wk = 2 average meals Shrimp Canned light tuna Pollock catfish Georgia Seafood Safety Website http://gaepd.org/Documents/fish_guide.htmlFood Safety in Pregnancy: Food Safety in Pregnancy Toxoplasmosis Parasite Prevention Wash hands after gardening, food preparation Wash utensils after food preparation Cook meat completely Wash and/or peel fruits & vegetables Avoid changing litter box: The End You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.