Thank You for Your Help! s1
Total Page：16
File Type：pdf, Size：1020Kb
The Fit for Delivery Team Some questions about you: (ver. 090112)
001. Participant number weight? 551 000-700 000 (please write clearly): 701 000 -850 000 ______kg ______ Over 850 000 Do not wish to ______009. What is your highest answer 002. What is your date of level of education? birth? (Choose one) Less than 7 years of 012. Have you been on a ______diet within the last year? ______primary education Primary education, No, my weight is 7-10 years fine 003. How far along are Trade school or 1-2 No, but I needed to you in your pregnancy? years lose weight of secondary Yes ______education weeks 3 years of secondary education 013. Do you smoke? 004. What was your College/university, Never smoked weight immediately Less than 4 years Smoked before I before becoming became pregnant, but College/university, pregnant? have stopped 4 years or more completely ______kg 010. What is your primary Smoke 1-4 cigs / activity? day 005. How tall are you? (in Working outside the Smoke 5-9 cigs / cm) home day Student Smoke 10-20 cigs / ______cm Unemployed day Prolonged sick Smoke > 20 cigs / 006. With whom do you leave/disabled day live? Homemaker husband/partner/ boyfriend parents 011. What was your friends household’s combined live alone income last year? Include all income from wages, disability payments, social 007. If you live with the assistance, investment baby’s father, how tall is dividends, etc. (in krone) 014. Do you use snuff? he? (in cm) Under 125 000 Have never used snuff ______cm 125 000-200 000 201 000-300 000 008. If you live with the 301 000-400 000 baby’s father, what is his 401 000-550 000 Used snuff etc.): 023. To what extent does occasionally before I your health limit your became pregnant, but activities of daily life? have stopped (choose one): completely To a large extent Used snuff regularly To some extent 020. Have you ever used before I became Very little any form of pregnant, but have Not at all stopped completely drugs/narcotics? Never tried Use snuff 024. If you are employed occasionally Used drugs regularly outside the home, have you Use snuff daily, before I became had more than 1 week of about pregnant, but have sick leave during the past stopped completely month ? 015. _____ doses per Have tried drugs in Yes the past, but have day No stopped completely Use drugs 025. If yes, how long have 016. Do you use any occasionally you had sick leave? (choose medication daily? Use drugs on a the answer that fits best): No weekly basis 1-2 weeks, partial Yes sick leave 021. If yes, which? (name 1-2 weeks, of drug/ narcotic): 017. If yes, which? (Name complete sick leave of medication): 2-3 weeks, partial sick leave 2-3 weeks, complete sick leave 022. How would you 3-4 weeks, partial describe your own health? sick leave 018. Do you use any (choose one): 3-4 weeks, vitamins or supplements Very good daily? complete sick leave Good No 4+ weeks, partial Neither good nor Yes sick leave bad 4+ weeks, complete Poor 019. If yes, which? (name sick leave of supplement- iron, folate, Very poor
Physical activity
We would now like to ask you activities: Go to 028. During the last 7 days, about the physical activities question 28. on how many days did you do you do. We are interested in moderate physical activities information about different like carrying light loads, kinds of physical activity that bicycling at a regular pace, or are part of women’s daily light jogging? Do not include lives. Please answer all 027. How much time did you walking. questions, regardless of how usually spend on one of those active you believe yourself to days doing vigorous physical _____ days be. Think of activities you do activities? at work, as part of your No moderate physical house and yard work, to get 0. Don’t know activities: Go to from place to place, and in 1. 10 minutes question 30. your spare time (for 2. 20 minutes recreation, exercise or 3. 30 minutes sport). We ask two sets of questions: We would first like 4. 40 minutes you to tell us about your 5. 50 minutes activities during the last 6. 1 hour seven days. After that, we 7. 1 hour and 10 are interested in your minutes 029. How much time did you physical situation in the 8. 1 hour and 20 usually spend on one of those period right before you minutes days doing moderate physical became pregnant. 9. 1 hour and 30 activities? minutes 10. 1 hour and 40 0. Don’t know Think of all vigorous physical minutes 1. 10 minutes activities you have performed 2. 20 minutes over the last 7 days. Vigorous 11. 1 hour and 50 3. 30 minutes physical activities refer to minutes activities that take hard 12. 2 hours or more 4. 40 minutes physical effort and make you 5. 50 minutes breathe much harder than 6. 1 hour normal. Include only those Think of all moderate 7. 1 hour and 10 activities that last for at physical activities you have minutes done over the last 7 days. least 10 minutes at a time. 8. 1 hour and 20 Moderate physical activities minutes are activities that take moderate physical effort and 9. 1 hour and 30 026. During the last 7 days, minutes on how many days did you do make you breathe somewhat 10. 1 hour and 40 vigorous physical activities harder than normal. Include minutes like heavy lifting, digging, only those activities that last aerobics or fast biking? for at least 10 minutes at a 11. 1 hour and 50 time. minutes _____ days 12. 2 hours or more
No vigorous physical 4 weekdays while at work, at 033. How many days during a home, while doing course typical week did you do Think about the time you work and during leisure time. vigorous physical activities have spent walking during This includes time spent like heavy lifting, digging, the last 7 days. This includes sitting at a desk, visiting aerobics or fast biking? walking at work and at home, friends, reading, traveling on walking to travel from place a bus or sitting or lying down _____ days to place, and any other to watch television. walking that you did solely No vigorous physical for recreation, sport, activities: Go to exercise or leisure. 032. During the last 7 days, question 35. how much time in total did 030. During the last 7 days, on you usually spend sitting on a how many days did you walk week day? for at least 10 minutes at a time? Answer: ______hours 034. How much time did you _____ days usually spend on one of those days doing vigorous physical Didn’t walk: Go to question activities? 32. We would now like you to 0. Don’t know think back to the time right 1. 10 minutes before you became pregnant. 2. 20 minutes Try to imagine a typical week 3. 30 minutes 031. How much time in total during that time. Think of 4. 40 minutes did you usually spend walking activities you did at work, as on one of those days? part of your house and yard 5. 50 minutes 0. Don’t know work, to get from place to 6. 1 hour 1. 10 minutes place, and in your spare time 7. 1 hour and 10 (for recreation, exercise or 2. 20 minutes minutes sport). 8. 1 hour and 20 3. 30 minutes minutes 4. 40 minutes Think of all vigorous physical 9. 1 hour and 30 5. 50 minutes activities you performed minutes 6. 1 hour during a typical week (7 10. 1 hour and 40 7. 1 hour and 10 days) right before you minutes became pregnant. Vigorous minutes 11. 1 hour and 50 physical activities refer to 8. 1 hour and 20 minutes activities that take hard minutes 12. 2 hours or more 9. 1 hour and 30 physical effort and make you minutes breathe much harder than normal. Include only those 10. 1 hour and 40 activities that last for at minutes least 10 minutes at a time. 11. 1 hour and 50 Think of all moderate minutes physical activities you 12. 2 hours or more performed during a typical week (7 days) right before The next question is about you became pregnant. the time you spent sitting on Moderate physical activities 5 are activities that take 9. 1 hour and 30 on one of those days? moderate physical effort and minutes 0. Don’t know make you breathe somewhat 10. 1 hour and 40 1. 10 minutes harder than normal. Include minutes 2. 20 minutes only those activities that last 11. 1 hour and 50 3. 30 minutes for at least 10 minutes at a minutes time. 4. 40 minutes 12. 2 hours or more 5. 50 minutes 035. How many days during a 6. 1 hour typical week did you do 7. 1 hour and 10 moderate physical activities minutes like carrying light loads, 8. 1 hour and 20 bicycling at a regular pace, or minutes light jogging? Do not include 9. 1 hour and 30 walking. minutes 10. 1 hour and 40 _____ days minutes 11. 1 hour and 50 No moderate physical Think about the time you minutes activities: Go to have spent walking during a 12. 2 hours or more question 37. typical week (7 days) right before you became The next question is about pregnant. This includes the time you spent sitting on walking at work and at home, weekdays during a typical walking to travel from place week (7 days) before you to place, and any other became pregnant. Include 036. How much time did you walking that you did solely usually spend on one of those time you spent sitting while for recreation, sport, at work, at home, while days doing moderate physical exercise or leisure. activities? doing course work and during leisure time. This includes 037. How many days during a 0. Don’t know time spent sitting at a desk, typical week did you walk for visiting friends, reading, 1. 10 minutes at least 10 minutes at a time? traveling on a bus or sitting 2. 20 minutes or lying down to watch 3. 30 minutes _____ days television. 4. 40 minutes 5. 50 minutes Didn’t walk: Go to question 6. 1 hour 39. 039. How much time in total 7. 1 hour and 10 did you usually spend sitting minutes on a week day during a typical week? 8. 1 hour and 20 minutes 038. How much time in total Answer: ______hours did you usually spend walking
6 (040-042) Think further back in time. How often did you do a sport or physical activity that was so intense that you became sweaty and/or breathless when you were: (Make a mark for each age group)?
When I was When I was When I was between younger than 10: 10 to 14: 15 and 20:
Never Less than 1 x/month 1-3 x/month 1 /week 2-3 x/week 4-6 x/week Every day
How do you usually get to work/school? Before pregnancy: Now: (043): (044): Walk Bike Public transportation (bus, train, etc.) Car Motorcycle, scooter or moped Not applicable (not working, going to school)
Below you will find a list of reasons for NOT doing physical activities. Please mark one or more boxes for the reason(s) that are most important for you:
Before pregnancy: Now:
(045/065) Don’t have the time (046/066) Can’t afford it (047/067) Transportation problems (048/068) Negative experiences (049/069) Problems with mobility (050/070) Don’t think I can do it (051/071) Don’t have the energy (052/072) Afraid to get hurt (to fall, get a sprain) (053/073) Would rather use my time on other things (054/074) Because of my physical health (055/075) Don’t have anyone to do physical activities with me
7 (056/076) Schedules don’t fit for me (057/077) Don’t know of anything available to me (058/078) Afraid to go out (059/079) Nothing available in my area of interest (060/080) Because of nausea (061/081) Fear of urinary incontinence (062/082) Afraid to harm the baby (063/083) Pelvic pain
If you have other reasons, please explain:
064. Before pregnancy: ______
085. Now: ______
1.
8 What do you usually eat?
When you answer these Less than once Never questions, think about what a week Less than once you usually ate and drank Once a week a week before you became pregnant Twice a week Once a week and what you eat and drink 3 times a week Twice a week now. Consider what you eat 4 times a week 3 times a week at home, at work, and in 5 times a week 4 times a week your spare time. Mark the 6 times a week 5 times a week box that you feel best fits for Every day 6 times a week you. Please answer every Every day question for both before Several times pregnancy and now. (092-093). How often did you/do you eat a late supper each (kveldsmat)? day (086-087). How often did Before Now you/do you eat breakfast? Never (098-099). How often did Before Now Less than once you/do you drink low-fat Never a week milk? Less than once Once a week Before Now a week Twice a week Never Once a week 3 times a week Less than once Twice a week 4 times a week a week 3 times a week 5 times a week Once a week 4 times a week 6 times a week Twice a week 5 times a week Every day 3 times a week 6 times a week 4 times a week Every day (094-095). How often did 5 times a week you/do you eat snacks? 6 times a week (088-089). How often did Before Now Every day you/do you eat lunch? Never Several times Before Now Less than once each Never a week day Less than once Once a week a week Twice a week Once a week 3 times a week Twice a week 4 times a week 3 times a week 5 times a week 4 times a week 6 times a week (100-101). How often did 5 times a week Every day you/do you drink skimmed 6 times a week Several times milk? Every day each Before Now Never (090-091). How often did day you/do you eat dinner? Less than once Before Now a week (096-097). How often did Never Once a week you/do you drink whole milk? Twice a week Before Now 9 3 times a week Less than once 4 times a week a week 5 times a week Once a week 6 times a week Twice a week Every day 3 times a week Several times 4 times a week each (106-107). How often did 5 times a week day you/do you drink soda/punch 6 times a week – with sugar? Every day (102-103). How often did Before Now Several times you/do you drink juice? Never each Before Now Less than once day Never a week Less than once Once a week (112-113). How often did a week Twice a week you/do you drink tap water? Once a week 3 times a week Before Now Twice a week 4 times a week Never 3 times a week 5 times a week Less than once 4 times a week 6 times a week a week 5 times a week Every day Once a week 6 times a week Several times Twice a week Every day each 3 times a week Several times day 4 times a week each 5 times a week day (108-109). How often did 6 times a week you/do you drink soda/punch Every day —without sugar? Several times (104-105). How often did Before Now each you/do you drink fruit nectar? Never day Before Now Less than once Never a week Less than once Once a week (114-115). How often did a week Twice a week you/do you drink bottled Once a week 3 times a week 4 times a week water (without carbonation Twice a week or flavor added)? 5 times a week 3 times a week Before Now 6 times a week 4 times a week Never Every day 5 times a week Less than once Several times 6 times a week a week each Every day Once a week day Several times Twice a week each 3 times a week day (110-111). How often did 4 times a week you/do you drink beverages 5 times a week that contain alcohol? 6 times a week Before Now Every day Never
10 Several times Twice a week vegetables (for example, each 3 times a week carrots at lunchtime)? day 4 times a week Before Now 5 times a week Never (116-117). How often did 6 times a week Less than once you/do you drink bottled Every day a week water with carbonation or Several times Once a week flavor added? each Twice a week Before Now day 3 times a week 4 times a week Never (122-123). How often did Less than once you/do you eat vegetables at 5 times a week a week dinner? 6 times a week Once a week Before Now Every day Twice a week Never Several times 3 times a week Less than once each 4 times a week a week day 5 times a week Once a week 6 times a week Twice a week (128-129). How often did Every day 3 times a week you/do you eat apples, Several times 4 times a week oranges, pears or bananas? each 5 times a week Before Now day 6 times a week Never Every day Less than once (118-119). How often did Several times a week you/do you drink coffee? each Once a week Before Now day Twice a week Never 3 times a week Less than once 4 times a week a week (124-125). How often did 5 times a week Once a week you/do you eat vegetables on 6 times a week Twice a week your sandwich? Every day 3 times a week Before Now Several times 4 times a week Never each 5 times a week Less than once day 6 times a week a week (130-131). How often did Every day Once a week you/do you eat other fruits or Several times Twice a week berries (fruits or berries each 3 times a week other than apples, oranges, day 4 times a week pears or bananas)? 5 times a week Before Now 6 times a week Never (120-121). How often did Every day Less than once you/do you eat potatoes? Several times a week Before Now each Once a week Never day Twice a week Less than once 3 times a week 4 times a week a week (126-127). How often did Once a week you/do you eat other 5 times a week 11 6 times a week Less than once (142-143). How often did Every day a week you/do you eat cereal Several times Once a week containing sugar? each Twice a week Before Now day 3 times a week Never 4 times a week Less than once a week (132-133). How often did 5 times a week you/do you eat fruits or 6 times a week Once a week vegetables as snacks? Every day Twice a week Before Now Several times 3 times a week Never each 4 times a week Less than once day 5 times a week 6 times a week a week (138-139). How often did Once a week you/do you eat cake, muffins, Every day Twice a week etc.? Several times 3 times a week Before Now each 4 times a week Never day 5 times a week Less than once 6 times a week a week (144-145). How often did Every day Once a week you/do you eat plain yogurt Several times Twice a week (yogurt without added sugar)? each 3 times a week Before Now day 4 times a week Never 5 times a week Less than once (134-135). How often did 6 times a week a week you/do you eat cookies or Every day Once a week crackers? Several times Twice a week Before Now each 3 times a week Never day 4 times a week Less than once 5 times a week a week 6 times a week Once a week (140-141). How often did Every day Twice a week you/do you eat cereal without Several times 3 times a week added sugar? each 4 times a week Before Now day 5 times a week Never (146-147). How often did 6 times a week Less than once you/do you eat yogurt with Every day a week added sugar? Several times Once a week Before Now each Twice a week Never day 3 times a week Less than once 4 times a week a week (136-137). How often did 5 times a week Once a week you/do you eat sweet buns 6 times a week Twice a week (sweet rolls, “boller”, etc)? Every day 3 times a week Before Now Several times 4 times a week Never each 5 times a week day 6 times a week 12 Every day Less than once Several times Several times a week each each Once a week day day Twice a week 3 times a week (158-159). How often did 4 times a week you/do you add sugar to the (148-149). How often did 5 times a week food you eat? you/do you eat instant 6 times a week Before Now noodles (for example, Mr. Every day Never Lee)? Several times Less than once Before Now each a week Never day Once a week Less than once Twice a week a week (154-155). How often did 3 times a week Once a week you/do you eat hot dogs/ 4 times a week Twice a week sausages from a gas station or 5 times a week 3 times a week kiosk? 6 times a week 4 times a week Before Now Every day 5 times a week Never Several times 6 times a week Less than once each Every day a week day Several times Once a week (160-161). How often did each Twice a week you/do you add salt to the day 3 times a week food you eat? 4 times a week Before Now 5 times a week Never (150-151). How often did 6 times a week Less than once you/do you eat potato Every day a week chips/other salty snacks? Several times Once a week Before Now each Twice a week Never day 3 times a week Less than once 4 times a week a week 5 times a week (156-157). How often did Once a week 6 times a week Twice a week you/do you eat french fries from a fast-food chain? Every day 3 times a week Before Now Several times 4 times a week Never each 5 times a week Less than once day 6 times a week a week (162-163). How often did Every day Once a week you/do you eat industrially Several times Twice a week processed food for dinner? each 3 times a week (freeze-dried instant food, og day 4 times a week pre-cooked meals) (152-153). How often did 5 times a week Before Now you/do you eat chocolate/ 6 times a week Never other sweets? Every day Less than once Before Now a week Never Once a week 13 Twice a week 6 times a week 3 times a week Every day 4 times a week Several times 5 times a week each 6 times a week day Every day
(164-165). How often did (168-169). When you buy you/do you eat so much that groceries, how often did you are more than full (feel you/do you check the that you have eaten too ingredient list? Which size did you/do you much)? Before Now usually choose when you buy: Before Now Never Never Once in a while Before you became pregnant: Less than once Usually a week Always Large Small Once a week (171) Potato chips 350g Twice a week 150g 3 times a week (173) chocolate ≥80g 4 times a week <80g 5 times a week (175) Soda 1,5l 6 times a week 0,5l Every day Several times each day Now:
Large Small (171) Potato chips 350g (166-167). How often did 150g you/do you eat candy, salty (173) chocolate ≥80g snacks or other unhealthy <80g food even if you don’t think it (175) Soda 1,5l tastes very good? 0,5l Before Now Never Less than once a week Once a week Twice a week 3 times a week 4 times a week 5 times a week In this last section, we would like you to mark what you ate and drank yesterday: Yes No 176. Breakfast
14 177. Lunch 206. Chocolate/other sweets 178. Dinner 207. Hot dog from kiosk/gas 179. Late supper station 180. Snack 208. French fries from fast-food chain 181. Whole milk 182. Low-fat milk 183. Skimmed milk 209. Industrially processed food, liked 184. Juice freeze-dried or pre-cooked food? 185. Fruit nectar 186. Soda/punch with sugar 210. Did you add SUGAR to your 187. Soda/punch without sugar food yesterday? 188. Beverages containing alcohol 211. Did you add SALT to your food yesterday? 189. Tap water 190. Bottled water, plain Did you buy the following 191. Bottled water with carbonation yesterday? (Make a mark for each or added flavor food item) 192. Potatoes Yes No 193. Vegetables at dinner (212) Potato chips 194. Vegetables on a sandwich (213) Chocolate (214) Soda 195. Other vegetables (for example, carrots at lunch) 196. Apple, orange, If you answered “yes”, which size did you buy? pear or banana 197. Other fruits or berries Large (other than apple, orange, Small pear or banana) (215) Potato chips 198. Sweet buns (sweet rolls, (216) Chocolate “boller”, etc) (217) Soda 199. Cake, muffins, etc. 200. Cereal without added sugar (218) Which day of the week was it 201. Cereal containing sugar yesterday? Monday 202. Plain yogurt/yogurt Tuesday without added sugar Wednesday 203. Yogurt with added sugar Thursday Friday 204. Instant noodles Saturday (for example, Mr. Lee) Sunday 205. Potato chips/other salty snacks (219) Was yesterday a completely normal weekday?
15 Yes No
16