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DAILY MEDICATIONS PRIOR TO PREGNANCY SURVEY

Pregnancy Info

Thank you for your willingness to answer this brief survey. This is an anonymous survey and we will not collect your contact information.

This survey is being conducted by the HER Foundation and the University of Southern California with researchers, Dr. Marlena Fejzo and Kimber MacGibbon, RN.
HER Foundation
1. How many pregnancies have you had? *This question is required.
This question requires a valid number format.
This question requires a valid number format.
5. What is your race/ethnicity/ancestry? *This question is required.
In the month BEFORE getting pregnant with your 1st child, did you take any of these medications daily (please review list carefully and check all that apply)


  *This question is required.
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In the month BEFORE getting pregnant with your 2nd child, did you take any of these medications daily (please review list carefully and check all that apply)


  *This question is required.
  • * This question is required.
In the month BEFORE getting pregnant with your 3rd child, did you take any of these medications daily (please review list carefully and check all that apply)

  *This question is required.
  • * This question is required.
In the month BEFORE getting pregnant with your 4th child, did you take any of these medications daily (please review list carefully and check all that apply)


  *This question is required.
  • * This question is required.
In the month BEFORE getting pregnant with your 5th child, did you take any of these medications daily (please review list carefully and check all that apply)


  *This question is required.
  • * This question is required.
In the month BEFORE getting pregnant with your 6th child, did you take any of these medications daily (please review list carefully and check all that apply)

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In the pregnancy with your 1st child, did you have *This question is required.
In the pregnancy with your 2nd child, did you have
  *This question is required.
In the pregnancy with your 3rd child, did you have *This question is required.
In the pregnancy with your 4th child, did you have *This question is required.
In the pregnancy with your 5th child, did you have *This question is required.
In the pregnancy with your 6th child, did you have *This question is required.
6. Are you aware of any medications or treatments used in the month prior to pregnancy that may help lower your risk of getting more severe symptoms of nausea and vomiting of pregnancy or HG? *This question is required.
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