Protocol - Mother and Baby Health

1. For your last pregnancy, did any of the following occur? Choose all that apply.

1[ ]Preterm birth (birth of baby less than 37 weeks gestational age)

2[ ]Baby with low birth weight (less than 5 pounds 8 ounces)

3[ ]Baby with birth defects

4[ ]Placenta previa

5[ ]Placenta abruption

6[ ]Pre-eclampsia

7[ ]None of the above

-8[ ]DON’T KNOW

-9[ ]REFUSED

2. During your most recent pregnancy, did a healthcare provider tell you that you had any of the following health conditions?

1[ ]Gestational diabetes (diabetes that started during this pregnancy)

2[ ]High blood pressure (that started during this pregnancy), pre-eclampsia, or eclampsia

3[ ]Depression

4[ ]Anxiety

3. What was the outcome of your last pregnancy?

1[ ]Live birth

2[ ]Miscarriage

3[ ]Abortion

4[ ]Ectopic or tubal pregnancy

5[ ]Stillbirth

6[ ]None of the above

-8[ ]DON’T KNOW

-9[ ]REFUSED

4. In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day?

1[ ]More than one pack (21 or more cigarettes)

2[ ]One-half to one pack (11 to 20 cigarettes)

3[ ]Less than half a pack (1 to 10 cigarettes)

4[ ]I didn’t smoke then

5. In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day?

1[ ]More than one pack (21 or more cigarettes)

2[ ]One-half to one pack (11 to 20 cigarettes)

3[ ]Less than half a pack (1 to 10 cigarettes)

4[ ]I didn’t smoke then

6. Did you quit smoking around the time of your most recent pregnancy? Check ONE answer.

[ ] No

[ ] No, but I cut back

[ ] Yes, I quit before I found out I was pregnant

[ ] Yes, I quit when I found out I was pregnant

[ ] Yes, I quit later in my pregnancy

7. During the 3 months before you got pregnant, on average, how often did you use e-cigarettes (“vapes”) or other electronic nicotine products?

1[ ]Everyday

2[ ]Some days

3[ ]I didn’t use e-cigarettes or other electronic nicotine products then

8. During the last 3 months of your pregnancy, how often did you use e-cigarettes (“vapes”) or other electronic nicotine products?

1[ ]Everyday

2[ ]Some days

3[ ]I didn’t use e-cigarettes or other electronic nicotine products then

9. After your baby was born, how long did he or she stay in the hospital?

[ ] Less than 3 days

[ ] 3 to 5 days

[ ] 6 to 14 days

[ ] More than 14 days

[ ] My baby was not born in a hospital

[ ] My baby is still in the hospital

10. Is your baby alive now?

[ ] No

[ ] Yes