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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.
  • * This question is required.
How many medications/substances did you use prior to your 1st pregnancy?
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the first medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the second medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the third medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the fourth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the fifth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the sixth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
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.
How many medications/substances did you use prior to your 2nd pregnancy?
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the first medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the second medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the third medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the fourth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the fifth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *This question is required.
We're asking a few details about each medication or substance you selected. Please write in answers for A-D for the sixth medication or substance you used. 
            ​
A. Name of medication or substance
(example: Ibuprofen)
            ​
B. Reason for use
​(example: diagnosed with migraines)
            ​
C. How long did you use this medication before pregnancy?
We define "before pregnancy" as before the last menstrual period you had before becoming pregnant. If you do not have a regular period, use the time period before you knew you were pregnant.
(example: 3 months before last menstrual period)
            ​
D. How long did you use this medication during pregnancy? If you have had more than one pregnancy, please note how long you used it in each pregnancy
(example: stopped two weeks after last menstrual period for first pregnancy; used for 36 weeks during second pregnancy)​ *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)

  *This question is required.
  • * This question is required.
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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