Have you ever had a miscarriage? A. No. B. Yes, one time. C. Yes, two times. D. Yes, more than twice. 4. How many live births have you had? A. None. B. One. C. Two. D. More than two. 5. Have you ever had a baby born prematurely or stillborn? A. Yes. B. No. 6. Do you smoke? A. No. B. Yes, less than 10 cigarettes a day. C. Yes, more than 10 cigarettes a day. 7. Would you say your nutrition before you got pregnant was: A. Good. B. Poor. C. Not sure. 8. Would you say your nutrition now is: A. Good. B. Poor. C. Not sure. D. It varies from day to day. 9. Do you currently drink alcohol (including beer and wine)? A. Yes, two or more drinks a day. B. Yes, about one drink a day. C. Yes, about one drink a week. D. No. 10. Do you currently take any medications? A. Yes, medications prescribed by my primary health care provider. B. Yes, over-the-counter medications.