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Protocol - Family History of Pregnancy Complications

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Description:

A two-item, multi-part set of interviewer-administered questions about the woman’s family members who have had pregnancy complications. The relationship between the woman and her family members and the list of pregnancy complications are coded.

Protocol:

1. Have any of your biological mother, sisters, half-sisters, or female first cousins ever had any of the following pregnancy complications?

a. Delivery of a child more than 3 weeks before the expected due date

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

b. Delivery of a child weighing less than 5 lb 8 oz (or 2500 grams)

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

c. Spontaneous preterm delivery (<37 weeks)

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

d. Early or preterm rupture of the membranes

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

e. Preeclampsia, eclampsia, toxemia, or pregnancy-induced hypertension

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

f. Induction of labor due to low amniotic fluid or poor fetal growth

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

g. Stillbirth

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

h. Delivery of an infant with a birth defect

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

i. Other pregnancy complication, specify

[ ] 01 Yes

[ ] 02 No

[ ] -8 Don’t know

      1. Specify ____________________

IF YES TO ANY OF THE ABOVE [COMPLETE #2]

IF NO OR DON’T KNOW TO ALL OF THE ABOVE [END]

2. For each family member, tell me the relation and the pregnancy complications. (Use codes in lists below)

Code Family Relation and up to five pregnancy complications for any family member

a. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

b. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

c. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

d. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

e. Family relation code ________

Pregnancy complication 1 _________

Pregnancy complication 2 _________

Pregnancy complication 3 _________

Pregnancy complication 4 _________

Pregnancy complication 5 _________

Other specify pregnancy complication 1 _________

Other specify pregnancy complication 2 _________

Codes for Question #2

Codes for Family Relation to Participant

01 = Participant’s mother

02 = Participant’s sister/half-sister

03 = Participant’s female first cousin, maternal

04 = Participant’s female first cousin, paternal

Codes for Pregnancy Complication

01 = Delivery of a child more than 3 weeks before the expected due date

02 = Delivery of a child weighing less than 5 lb 8 oz (or 2500 grams)

03 = Spontaneous preterm delivery (<37 weeks)

04 = Early or preterm rupture of the membranes

05 = Preeclampsia, eclampsia, toxemia or pregnancy induced hypertension

06 = Induction of labor due to low amniotic fluid or poor fetal growth

07 = Stillbirth

08 = Delivery of an infant with a birth defect

09 = Other pregnancy complication (SPECIFY)

Protocol Name from Source:

Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) Difficulties in Pregnancy, Maternal Interview Visit 2

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult, Pregnancy

Participants:

Pregnant women

Specific Instructions:

None

Selection Rationale

The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) is a major prospective cohort study collecting data from the first trimester of pregnancy through the end of pregnancy on approximately 10,000 nulliparous women. The protocols, consent forms, and data collection instruments were developed by the nuMoM2b investigators in collaboration with Project Scientists from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and vetted by an independent Advisory and Safety Monitoring Board reporting to NICHD.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Pregnancy Complication Family History Assessment Text 5633895 CDE Browser
Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) Difficulties in Pregnancy, Maternal Interview Visit 2, version 4, Form V2A, December 9, 2011. Questions 6 & 7.

General References

Haas, D. M., Parker, C. B., Wing, D. A., Parry, S., Grobman, W. A., Mercer, B. M., Simhan, H. N., Hoffman, M. K., Silver, R. M., Wadhwa, P., Iams, J. D., Koch, M. A., Caritis, S. N., Wapner, R. J., Esplin, M. S., Elovitz, M. A., Foroud, T., Peaceman, A. M., Saade, G. R., Willinger, M., & Reddy, U. M. (2015). NuMoM2b study. American Journal of Obstetrics and Gynecology, 212(4), 539.e1--539.e24.

Protocol ID:

240801

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
Research Domain Information
Measure Name:

Family History of Pregnancy Complications

Release Date:

January 31, 2017

Definition

Questions to assess a woman’s family history of pregnancy complications

Purpose

Researchers should be knowledgeable about a woman’s family history of pregnancy complications because some complications may be passed from one generation to the next.

Keywords

Pregnancy, fertility problems, miscarriage, premature delivery, preterm delivery, premature rupture of membranes, stillbirth, birth defects, nuMoM2b