Demography
Subject ID Number
integer
Age
integer
Date of Birth
date
Weight (kilogram)
float
Weight (pounds)
float
Height (centimeters)
float
Height (inches)
float
Race
text
Child Information
Baby Number
integer
Sex
text
Height (centimeters)
float
Height (inches)
float
Weight (kilograms)
float
Weight (pounds)
float
Apgar score 1 min
integer
Apgar score 5 min
integer
Outcome of pregnancy
text
If Spontaneous or Elective abortion, record the date
date
if Abnormal baby, congenital abnormality, stillborn, died at birth
text
Date of congenital abnormality identified/diagnosed
date
Pregnancy Outcome Information
Baby number
integer
Date of delivery
date
Length of gestation (weeks)
integer
select one
text
include live and stillbirth; if none, enter a zero
integer
Comments
text
Important Note
If pregnancy outcome is serious (spontaneous abortion, congenital abnormality, stillbirth, prolonged hospitalization, etc.) please submit the SAE report.
text