Prematurity Quiz - Dr. Barbara Luke

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The following questionnaire includes the 60 proven risks associated with preterm delivery, birth before 37 completed weeks' gestation. This questionnaire is a starting point for your personal assessment of your characteristics and factors in your daily life. The answers will pinpoint the risks currently present in your life--risks that you should reduce to improve your chances of having a healthy pregnancy.

Family Background
1. Do you consider yourself African-American?	YesNo
2. Were you born in the United States?	YesNo
3. Are you younger than 18 or older than 35?	YesNo
4. Is your annual income less than $8,000 for a family of two, or less than $10,000 for a family of three?	YesNo
5. Are you a single parent?	YesNo
6. Do you have preschool children at home?	YesNo
7. Do you have more than two children at home?	YesNo
8. Do one or more elderly relatives live with you?	YesNo
Gynecological, Obstetrical, and Medical History Factors Before this pregnancy, have you had...
9. ...more than one spontaneous abortion?	YesNo
10. ...more than one induced abortion?	YesNo
11. ...any preterm births (<37 weeks' gestation)?	YesNo
Were any of your previous newborns...
12. ...born dead (stillborns)?	YesNo
13. ...less than 5.5 pounds at birth?	YesNo
14. ...dead within one month after birth?	YesNo
15. Do you have a history of infertility treatments?	YesNo
16. Did your mother take DES (diethylstilbesterol) when she was pregnant with you?	YesNo
17. Is this your first pregnancy?	YesNo
18. Have you given birth four or more times before?	YesNo
19. Did you have any preexisting medical conditions?	YesNo
Current Obstetrical Factors
20. Have you had any vaginal bleeding after 12 weeks?	YesNo
21. Do you have any placental complications?	YesNo
22. Have you been told you have an incompetent cervix?	YesNo
23. Do you have premature rupture of membranes?	YesNo
24. Have you had one or more vaginal infections?	YesNo
25. Are you pregnant with more than one baby (multiples)?	YesNo
Nutritional Historical Factors
26. Are you less than five feet tall?	YesNo
27. Can you pinch less than one inch of fat on your arm?	YesNo
28. Are you underweight for your height?	YesNo
29. Have you recently been dieting to lose weight?	YesNo
30. Have you recently had a major illness or surgery?	YesNo
Home and Work Environment Factors
31. Do you climb stairs at home?	YesNo
32. Do you do much lifting at home?	YesNo
33. Do you do much carrying at home?	YesNo
34. Do you do much standing at home?	YesNo
35. Is your home environment noisy?	YesNo
36. Do you spend much time driving (carpool, groceries, errands)?	YesNo
37. Is your job high-stress or physically demanding?	YesNo
38. Do you stand while commuting to and from work?	YesNo
39. Do you stand most of the time at work?	YesNo
40. Do you do much lifting at work?	YesNo
41. Does your job require much physical exertion?	YesNo
42. Do you have irregular work hours?	YesNo
43. Does your job involve shift work?	YesNo
44. Do you work more than 8 hours per day?	YesNo
45. Do you work more than 40 hours per week?	YesNo
46. Do you become fatigued at work?	YesNo
47. Is your work environment noisy?	YesNo
48. Are you under a lot of stress at work?	YesNo
49. Do you drive at work or commute to work?	YesNo
Lifestyle Factors
50. Do you drink alcohol?	YesNo
51. Do you smoke cigarettes?	YesNo
52. Do you drink more than 2 cups of coffee per day?	YesNo
If you participate in recreational exercise,
53. ...do you exercise on your back or until fatigued?	YesNo
54. ...do you exercise until you perspire?	YesNo
Nutritional Factors in the Current Pregnancy Have you been told that you have...
55. ...to eat more frequently (don't skip meals)?	YesNo
56. ...not gained enough weight before 20 weeks?	YesNo
57. ...not gained enough weight after 20 weeks?	YesNo
58. ...iron-deficiency anemia?	YesNo
59. ...an inadequate iron intake?	YesNo
60. ...an inadequate calcium intake?	YesNo