. Author manuscript; available in PMC: 2013 Jul 1.

Published in final edited form as: Obstet Gynecol. 2012 Jul;120(1):113–122. doi: 10.1097/AOG.0b013e3182595671

Table 1.

Questionnaire Medication Exposure: Primary Index Questions

Intake Interview Primary Index Questions^*	First-Trimester Interview Primary Index Questions
Menstrual “preloading” medicines taken before missed LMP: When you were expecting your last period, the one you didn’t have because you were pregnant, around [insert date], did you “preload” to prevent cramping or pain? What did you take? Anything else? How many days did you take _______________?	Menstrual “preloading” medicines taken before missed LMP: When you were expecting your last period, the one you didn’t have because you were pregnant, around [insert date], did you “preload” to prevent cramping or pain? What did you take? Anything else? How many days did you take _______________?
Prescribed or non-prescribed medicines taken between LMP and 6 weeks after LMP: Other than the medicine(s) you took to “preload” around [date]. we’re also interested in pain medicine you may have taken with or without a prescription for other reasons. Since medicines are so common for things like colds, injuries, the flu, fevers, headaches and other aches and pains, we’d like to know how often you used them. So, I’d like you to think about the time between your last period on [date] and [6 weeks after LMP]. Other than the “preloading” you just told me about, did you take any medicines like aspirin, Advil or ibuprofen, Tylenol or acetaminophen, Theraflu, Alka Seltzer_[ACOG1], or BC powder for other reasons like aches, pains or colds? What did you take? Anything else? How many days during that time did you take _______________?	Prescribed or non-prescribed medicines taken between LMP and 6 weeks after LMP: Other than the medicine(s) you took to “preload” around [date] we’re also interested in pain medicine you may have taken with or without a prescription for other reasons. Since medicines are so common for things like colds, injuries, the flu, fevers, headaches and other aches and pains, we’d like to know how often you used them. So, I’d like you to think about the time between your last period on [date] and [6 weeks after LMP]. Other than the “preloading” you just told me about, did you take any medicines like Aspirin, Advil or Ibuprofen, Tylenol or acetaminophen, Theraflu, Alka Seltzer, or BC powder for other reasons like aches, pains or colds? What did you take? Anything else? How many days during that time did you take __________?

Intake Interview Primary Index Questions^*

First-Trimester Interview Primary Index Questions

Menstrual “preloading” medicines taken before missed LMP:
When you were expecting your last period, the one you didn’t have because you were pregnant, around [insert date], did you “preload” to prevent cramping or pain?
What did you take? Anything else?
How many days did you take _______________?

Menstrual “preloading” medicines taken before missed LMP:
When you were expecting your last period, the one you didn’t have because you were pregnant, around [insert date], did you “preload” to prevent cramping or pain?
What did you take? Anything else?
How many days did you take _______________?

Prescribed or non-prescribed medicines taken between LMP and 6 weeks after LMP:
Other than the medicine(s) you took to “preload” around [date]. we’re also interested in pain medicine you may have taken with or without a prescription for other reasons. Since medicines are so common for things like colds, injuries, the flu, fevers, headaches and other aches and pains, we’d like to know how often you used them. So, I’d like you to think about the time between your last period on [date] and [6 weeks after LMP]. Other than the “preloading” you just told me about, did you take any medicines like aspirin, Advil or ibuprofen, Tylenol or acetaminophen, Theraflu, Alka Seltzer_[ACOG1], or BC powder for other reasons like aches, pains or colds?
What did you take? Anything else?
How many days during that time did you take _______________?

Prescribed or non-prescribed medicines taken between LMP and 6 weeks after LMP:
Other than the medicine(s) you took to “preload” around [date] we’re also interested in pain medicine you may have taken with or without a prescription for other reasons. Since medicines are so common for things like colds, injuries, the flu, fevers, headaches and other aches and pains, we’d like to know how often you used them. So, I’d like you to think about the time between your last period on [date] and [6 weeks after LMP]. Other than the “preloading” you just told me about, did you take any medicines like Aspirin, Advil or Ibuprofen, Tylenol or acetaminophen, Theraflu, Alka Seltzer, or BC powder for other reasons like aches, pains or colds?
What did you take? Anything else?
How many days during that time did you take __________?

LMP, last menstrual period; BC, Bernard and Commodore Council Powder.

There are two versions of our first-trimester interview, one for questions formatted for women who are still pregnant, and another modified for women who have already had a loss.