Pregnancy & Infant Health Instruments🔗
The Health V1 and Health V2 instruments comprise eight questionnaires, administered in person or remotely at study visits 1/2. Health V2-Infancy is completed by the caregiver about the child, while all other questionnaires are self-report. V1 and V2 questionnaires require 3–5 and 10 minutes each to complete, respectively. Quality control includes reviewing response distributions for potential outliers.
| Instrument | Acronym | Construct | Table Name |
|---|---|---|---|
| Health V1 – Health History | Healthhx | Pre-pregnancy and pregnancy health | pex_bm_health_preg__healthhx |
| Health V1 – Chronic Conditions | Chroncond | Chronic conditions and STIs in pregnancy | pex_bm_health_preg__chroncond |
| Health V1 – Illness | Illness | Illness during pregnancy | pex_bm_health_preg__illness |
| Health V1 – ER Admissions | ERhosp | ER visits and hospitalizations during pregnancy | pex_bm_health_preg__erhosp |
| Health V1 – Medications | Meds | Medication use during pregnancy | pex_bm_health_preg__meds |
| Health V1 – Exposures & Vaccines | Vacc | Vaccinations during pregnancy | pex_bm_health_preg__exp__vacc |
| Health V2 – Pregnancy | Healthv2 Preg | Health updates through delivery | pex_bm_healthv2_preg |
| Health V2 – Infancy | Healthv2 Inf | Delivery characteristics and birth outcomes | pex_bm_healthv2_inf |
Amidst powerful societal expectations to ‘do what’s best for the baby’ during pregnancy (i.e. by stopping substance use), up to half of pregnancies in the United States are unintended with 1 in 5 unwanted (Bearak et al. 2020). This discrepancy contributes to implicit bias against pregnant individuals who use substances as ‘not caring about their babies’ which is neither humane, nor evidence based (Massey et al., 2022). While cessation of substance use during pregnancy is universally recognized as optimal, the ability to make this “parental” sacrifice varies substantially between birthing individuals and within individuals between their different pregnancies (Level et al., 2024). Failure to recognize this inherent heterogeneity in pregnancy intention stigmatizes substance users who did not intend to want to become pregnant. Summarily, inclusion of pregnancy intention as a covariate in all studies that characterize prenatal substance exposure (in the absence of a strong justification otherwise) is thus strongly recommended to acknowledge myriad experiences of birthing parents who participated in HBCD who made this research possible.
ERhosp: Reasons for ER visit or hospitalization, captured from BioPortal ICD codes, were at times difficult for the participant to name or HBCD study staff to correctly find in the ICD database. For example, ER visits for routine care (no diagnosis) and false alarms (e.g., suspected water break) were frequently coded as "Don’t know."
Illness: lnesses are captured from either BioPortal ICD codes or WHO (World Health Organization) symptom codes, which were at times difficult for the participant to name or the HBCD staff to correctly find in the ICD or symptom database.
Meds: Medication names are queried from the RxNORM database and reasons for medication use are captured from ICD codes (from BioPortal ICD). Reasons for use were sometimes difficult for the participant to name and/or HBCD study staff to find in the ICD database. This was apparent with aspirin for preeclampsia prevention, as there was not an option for coding preventive use. Aspirin was later moved to the prenatal vitamin section as a result. Additionally, medications used PRN (“as needed”) were difficult for participants to report. Finally, although not asked, some medications were coded with dose, but this was not asked and should not be used.
The same coding issues identified at V1, including difficulty with ICD codes (from BioPortal ICD) and medication names (from RxNORM) apply to V2 instruments as well.
Out-of-range values were filtered (i.e. changed to "n/a") based on the following valid range values:
- Weight at birth (oz) (
pex_bm_healthv2_inf_001__01): ≤16 - Weight at birth (lbs) (
pex_bm_healthv2_inf_001__02): ≤66 - Length at birth (inches) (
pex_bm_healthv2_inf_002): 12-51 - Calculated length at birth (cm) (
pex_bm_healthv2_inf_002__01): 30-130
Instrument Details🔗
Below we outline the general information contained within each instrument in more detail.
| Acronym | Examples |
|---|---|
| Healthhx | Gravidity and parity, height and weight, pregnancy intentions, use of assisted reproductive technology, start of prenatal care, prenatal vitamin or aspirin use, secondhand smoke |
| Vacc | Vaccines in pregnancy including receipt of common vaccines in pregnancy and trimester received |
| Chroncond | Chronic conditions and sexually transmitted infections (STIs) during pregnancy, including whether they are ongoing or resolved |
| Illness | Illness in pregnancy, including start and stop dates and whether the person had a fever |
| ERhosp | ER visit(s) or hospitalization(s) during pregnancy, including occurrence and reason |
| Meds | Prescription and over-the-counter medications used during pregnancy, including name of medication, indication, frequency of use, and start/stop dates |
| Healthv2 Preg | Health updates for the birth parent between enrollment and delivery, including: prenatal vitamin use, aspirin intake, infections and illnesses, vaccinations, medication use (ongoing and newly prescribed), pregnancy complications (e.g., gestational diabetes), labor and delivery method, location, and hospital stay |
| Healthv2 Inf | Delivery and birth outcomes include infant characteristics (birth weight & length, duration of hospital stay); newborn conditions (birth defects, genetic diagnoses); medical interventions including NICU admission and length of stay, intubation, adverse outcomes (e.g. bronchopulmonary dysplasia, congenital syphilis), medications (name, indication, status), healthcare access, specialist visits, and newborn hearing test results |
Bearak, J., Popinchalk, A., Ganatra, B., Moller, A.-B., Tunçalp, Ö., Beavin, C., Kwok, L., & Alkema, L. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. The Lancet. Global Health, 8(9), e1152–e1161. https://doi.org/10.1016/S2214-109X(20)30315-6
Level, R. A., Zhang, Y., Tiemeier, H., Estabrook, R., Shaw, D. S., Leve, L. D., Wakschlag, L. S., Reiss, D., Neiderhiser, J. M., & Massey, S. H. (2024). Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study. Archives of Women’s Mental Health, 27(2), 301–308. https://doi.org/10.1007/s00737-023-01396-z
Massey, S. H., Neiderhiser, J. M., Shaw, D. S., Leve, L. D., Ganiban, J. M., & Reiss, D. (2012). Maternal self concept as a provider and cessation of substance use during pregnancy. Addictive Behaviors, 37(8), 956–961. https://doi.org/10.1016/j.addbeh.2012.04.002
Massey, S. H., Estabrook, R., Lapping-Carr, L., Newmark, R. L., Decety, J., Wisner, K. L., & Wakschlag, L. S. (2022). Are empathic processes mechanisms of pregnancy’s protective effect on smoking? Identification of a novel target for preventive intervention. Social Science & Medicine (1982), 305(115071), 115071. https://doi.org/10.1016/j.socscimed.2022.115071
Schoenaker, D. A. J. M., Ploubidis, G. B., Goodman, A., & Mishra, G. D. (2017). Factors across the life course predict women’s change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study. Journal of Epidemiology and Community Health, 71(12), 1137–1144. https://doi.org/10.1136/jech-2017-209493