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GDM questionnaire
It is a quick 2 min survey where we wont collect emails and it is absolutely anonymous.
Thank you for contributing to help in prediction of GDM.
Note: This questionnaire captures data for each pregnancy separately.
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1.Did you have Gestational Diabetes Mellitus(GDM)?
Yes
No
Clear selection
2.Your Age at pregnancy(two digit number)
Your answer
3.In what pregnancy you had GDM?
1
2
3
other
Clear selection
4.Did you have diabetes in your previous pregnancies?
Yes
No
Clear selection
5.What was your blood pressure at the last visit before pregnancy?(please fill in the following format 100/70)
Your answer
6.What is your Height in cms?
Your answer
7.What was your weight before pregnancy in pounds?
Your answer
8.Did you have any of following ailments?
Asthma
Hypertension
Cancer
Thyroid
Dyslipidemia
Tuberculosis
Vitamin D Deficiency
Vitamin B12 Deficiency
High triglycerides
others
9.If others for above please specify
Your answer
10.Do you have any allergies?
Yes
No
Clear selection
11.If you have allergies please specify
Your answer
12.Were you taking any medications before pregnancy(around the time of pregnancy)?
yes
No
Clear selection
13.If Yes to the above please specify
Your answer
14.Did you have any surgeries before pregnancy?
Yes
No
Clear selection
15.If Yes for previous surgeries please specify
Your answer
16.Do you have a family history of Diabetes?
Yes
No
Clear selection
17.Please check the following habits which apply to you
Smoking
Alcohol
vegetarian
Non-vegetarian
Exercise
18.Did you work around pregnancy time?
Yes
No
Clear selection
19.Were you stressful around pregnancy time?(Please rate it on a scale of 10)
0-5
5-10
Clear selection
20.Which area you were staying at around pregnancy time?
Your answer
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