|
Maternal demographic data |
| Characteristics |
|
|
| Name |
| Date of birth (dd/mm/yy) |
| Current age (yr) |
| Marital status (married/cohabitating/single) |
| Occupation (free text) |
| Partner's occupation (free text). |
| Discontinued full time education (Y/N) |
| Age full time education stopped (yr) |
| Smoking status |
| (never/quit pre-pregnancy/quit during pregnancy/currently smoking) |
| If currently smoking, number per day |
| Alcohol use (units per week) |
| Current |
| Pre-pregnancy |
| Current medical condition (free text) |
| Current prescription medication (free text) |
| Previous pregnancies ending less than 24-weeks (Y/N) |
| If yes 1. Gestational age (wks) 2. Spontaneous (Y/N) |
| Use of oral contraceptive pill in the last 3 months (Y/N) |
| Date of last menstrual period (dd/mm/yy) |
| Certain of date last menstrual period (Y/N) |
| Duration of menstrual cycle (/28 days) |
Pasupathy et al. BMC Pregnancy and Childbirth 2008 8:51 doi:10.1186/1471-2393-8-51 |