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Protocol - Family History of Pregnancy Complications

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Description:

A two-item, multi-part set of interviewer-administered questions about the woman’s family members who have had pregnancy complications. The relationship between the woman and her family members and the list of pregnancy complications are coded.

Specific Instructions:

None

Protocol:

1. Have any of your biological mother, sisters, half-sisters, or female first cousins ever had any of the following pregnancy complications?

a. Delivery of a child more than 3 weeks before the expected due date

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

b. Delivery of a child weighing less than 5 lb 8 oz (or 2500 grams)

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

c. Spontaneous preterm delivery (<37 weeks)

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

d. Early or preterm rupture of the membranes

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

e. Preeclampsia, eclampsia, toxemia, or pregnancy-induced hypertension

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

f. Induction of labor due to low amniotic fluid or poor fetal growth

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

g. Stillbirth

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

h. Delivery of an infant with a birth defect

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

i. Other pregnancy complication, specify

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

      1. Specify ____________________

IF YES TO ANY OF THE ABOVE [COMPLETE #2]

IF NO OR DON’T KNOW TO ALL OF THE ABOVE [END]

2. For each family member, tell me the relation and the pregnancy complications. (Use codes in lists below)

Code Family Relation and up to five pregnancy complications for any family member

a. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

b. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

c. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

d. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

e. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

Codes for Question #2

Codes for Family Relation to Participant

01 = Participant’s mother

02 = Participant’s sister/half-sister

03 = Participant’s female first cousin, maternal

04 = Participant’s female first cousin, paternal

Codes for Pregnancy Complication

01 = Delivery of a child more than 3 weeks before the expected due date

02 = Delivery of a child weighing less than 5 lb 8 oz (or 2500 grams)

03 = Spontaneous preterm delivery (<37 weeks)

04 = Early or preterm rupture of the membranes

05 = Preeclampsia, eclampsia, toxemia or pregnancy induced hypertension

06 = Induction of labor due to low amniotic fluid or poor fetal growth

07 = Stillbirth

08 = Delivery of an infant with a birth defect

09 = Other pregnancy complication (SPECIFY)

Protocol Name from Source:

Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) Difficulties in Pregnancy, Maternal Interview Visit 2

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult, Pregnancy

Participants:

Pregnant women

Selection Rationale

The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) is a major prospective cohort study collecting data from the first trimester of pregnancy through the end of pregnancy on approximately 10,000 nulliparous women. The protocols, consent forms, and data collection instruments were developed by the nuMoM2b investigators in collaboration with Project Scientists from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and vetted by an independent Advisory and Safety Monitoring Board reporting to NICHD.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Pregnancy Complication Family History Assessment Text 5633895 CDE Browser
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) Difficulties in Pregnancy, Maternal Interview Visit 2, version 4, Form V2A, December 9, 2011. Questions 6 & 7.

General References

Haas, D. M., Parker, C. B., Wing, D. A., Parry, S., Grobman, W. A., Mercer, B. M., Simhan, H. N., Hoffman, M. K., Silver, R. M., Wadhwa, P., Iams, J. D., Koch, M. A., Caritis, S. N., Wapner, R. J., Esplin, M. S., Elovitz, M. A., Foroud, T., Peaceman, A. M., Saade, G. R., Willinger, M., & Reddy, U. M. (2015). NuMoM2b study. American Journal of Obstetrics and Gynecology, 212(4), 539.e1--539.e24.

Protocol ID:

240801

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX240801_Pregnancy_History_Birth_Defect PX240801010800 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Delivery of an infant with a birth defect N/A
PX240801_Pregnancy_History_Family_1_Complication_1 PX240801020102 Family member #1: Pregnancy complication #1 N/A
PX240801_Pregnancy_History_Family_1_Complication_2 PX240801020103 Family member #1: Pregnancy complication #2 N/A
PX240801_Pregnancy_History_Family_1_Complication_3 PX240801020104 Family member #1: Pregnancy complication #3 N/A
PX240801_Pregnancy_History_Family_1_Complication_4 PX240801020105 Family member #1: Pregnancy complication #4 N/A
PX240801_Pregnancy_History_Family_1_Complication_5 PX240801020106 Family member #1: Pregnancy complication #5 N/A
PX240801_Pregnancy_History_Family_1_Relation PX240801020101 Family member #1: What is his or her family relation? N/A
PX240801_Pregnancy_History_Family_2_Complication_1 PX240801020202 Family member #2: Pregnancy complication #1 N/A
PX240801_Pregnancy_History_Family_2_Complication_2 PX240801020203 Family member #2: Pregnancy complication #2 N/A
PX240801_Pregnancy_History_Family_2_Complication_3 PX240801020204 Family member #2: Pregnancy complication #3 N/A
PX240801_Pregnancy_History_Family_2_Complication_4 PX240801020205 Family member #2: Pregnancy complication #4 N/A
PX240801_Pregnancy_History_Family_2_Complication_5 PX240801020206 Family member #2: Pregnancy complication #5 N/A
PX240801_Pregnancy_History_Family_2_Relation PX240801020201 Family member #2: What is his or her family relation? N/A
PX240801_Pregnancy_History_Family_3_Complication_1 PX240801020302 Family member #3: Pregnancy complication #1 N/A
PX240801_Pregnancy_History_Family_3_Complication_2 PX240801020303 Family member #3: Pregnancy complication #2 N/A
PX240801_Pregnancy_History_Family_3_Complication_3 PX240801020304 Family member #3: Pregnancy complication #3 N/A
PX240801_Pregnancy_History_Family_3_Complication_4 PX240801020305 Family member #3: Pregnancy complication #4 N/A
PX240801_Pregnancy_History_Family_3_Complication_5 PX240801020306 Family member #3: Pregnancy complication #5 N/A
PX240801_Pregnancy_History_Family_3_Relation PX240801020301 Family member #3: What is his or her family relation? N/A
PX240801_Pregnancy_History_Family_4_Complication_1 PX240801020402 Family member #4: Pregnancy complication #1 N/A
PX240801_Pregnancy_History_Family_4_Complication_2 PX240801020403 Family member #4: Pregnancy complication #2 N/A
PX240801_Pregnancy_History_Family_4_Complication_3 PX240801020404 Family member #4: Pregnancy complication #3 N/A
PX240801_Pregnancy_History_Family_4_Complication_4 PX240801020405 Family member #4: Pregnancy complication #4 N/A
PX240801_Pregnancy_History_Family_4_Complication_5 PX240801020406 Family member #4: Pregnancy complication #5 N/A
PX240801_Pregnancy_History_Family_4_Relation PX240801020401 Family member #4: What is his or her family relation? N/A
PX240801_Pregnancy_History_Family_5_Complication_1 PX240801020502 Family member #5: Pregnancy complication #1 N/A
PX240801_Pregnancy_History_Family_5_Complication_2 PX240801020503 Family member #5: Pregnancy complication #2 N/A
PX240801_Pregnancy_History_Family_5_Complication_3 PX240801020504 Family member #5: Pregnancy complication #3 N/A
PX240801_Pregnancy_History_Family_5_Complication_4 PX240801020505 Family member #5: Pregnancy complication #4 N/A
PX240801_Pregnancy_History_Family_5_Complication_5 PX240801020506 Family member #5: Pregnancy complication #5 N/A
PX240801_Pregnancy_History_Family_5_Relation PX240801020501 Family member #5: What is his or her family relation? N/A
PX240801_Pregnancy_History_Low_Amniotic_Fluid PX240801010600 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Induction of labor due to low amniotic fluid or poor fetal growth N/A
PX240801_Pregnancy_History_More_Three_Weeks_Premature PX240801010100 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Delivery of a child more than 3 weeks before the expected due date N/A
PX240801_Pregnancy_History_Other_Complications PX240801010900 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Other pregnancy complication, specify N/A
PX240801_Pregnancy_History_Preeclampsia PX240801010500 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Preeclampsia, eclampsia, toxemia, or pregnancy-induced hypertension N/A
PX240801_Pregnancy_History_Preterm_Membrane_Rupture PX240801010400 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Early or preterm rupture of the membranes N/A
PX240801_Pregnancy_History_Spontaneous_Preterm_Delivery PX240801010300 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Spontaneous preterm delivery (<37 weeks) N/A
PX240801_Pregnancy_History_Stillbirth PX240801010700 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Stillbirth N/A
PX240801_Pregnancy_History_Weight_Premature PX240801010200 Have any of your biological mother, sisters, half-sisters, or female first cousins ever had the following pregnancy complication? Delivery of a child weighing less than 5 lb 8 oz (or 2500 grams) N/A
Pregnancy
Measure Name:

Family History of Pregnancy Complications

Release Date:

January 31, 2017

Definition

Questions to assess a woman’s family history of pregnancy complications

Purpose

Researchers should be knowledgeable about a woman’s family history of pregnancy complications because some complications may be passed from one generation to the next.

Keywords

Pregnancy, fertility problems, miscarriage, premature delivery, preterm delivery, premature rupture of membranes, stillbirth, birth defects, nuMoM2b