Influence of Maternal Prenatal Vitamin D Status on Infant Oral Health

If you are taking vitamins during this pregnancy how <strong>of</strong>ten are you taking them?
Often (once a day or more) Sometimes (once a week or more, but less than once a day)
Rarely (less than once a week) Never
Do you feel that you should take vitamins for good prenatal health? Yes No Unsure
Would you take vitamins if you were not pregnant? Yes
No
Have you ever heard <strong>of</strong> vitamin D? Yes
No
What is vitamin D important for? _____________________________________________________
What foods have vitamin D in them? __________________________________________________
Have you ever heard <strong>of</strong> calcium? Yes No
What is calcium important for? ______________________________________________________
What foods have calcium in them? ___________________________________________________
Is calcium important during pregnancy for a healthy baby? Yes No Unsure
Do you take calcium supplements? Yes No Unsure
Do you have diabetes? Yes No Unsure
If yes, when did you first find out you were diabetic? _____________________________________
Do you suffer bone pain? Yes No Unsure
Do your arms or legs feel weak? Yes No Unsure
Do you have trouble walking (e.g. limp)? Yes No Unsure
Do you have problems standing up? Yes No Unsure
Do or did you suffer hip problems? Yes No Unsure
Do you smoke? Yes No
If yes, number each day? ______________, number <strong>of</strong> years? ______________
If no, did you ever smoke? Yes No
If yes, number each day? ______________, number <strong>of</strong> years? ______________
How interested are you in quitting smoking? Not at all A little Very
Do you drink any alcohol? Yes No If yes how <strong>of</strong>ten? __________________
Will you bring your baby to this medical clinic for checkups? Yes No Unsure
Nutrition Pr<strong>of</strong>ile/ Food Security Assessment:
Do you think that the foods you eat are healthy enough for this pregnancy? Yes No Unsure
How have you changed the way you eat since finding out you are pregnant?
Better Same Worse
Do you buy your groceries in your community? Yes No
Questionnaire Version 8 – May, 2002 Page 2 <strong>of</strong> 7