Introduction

The purpose of this questionnaire is to collect information from women who have suffered from PUPPP during their pregnancy. Currently, there is no known cause or cure for PUPPP except in most cases, childbirth. With the information gathered from this survey, maybe one day there will be. For more information on this questionnaire please email the originator, Robyn Westhoff

I would like to thank the members of our Yahoo Group who contributed to getting this survey up and running. Thank you !

For more medically current information, you should always consult your health practitioner. This is simply a questionnaire and not to be used as a guide to curing your PUPPP condition.

Instructions

Answer questions as they relate to you. For most answers, check the box(es) most applicable to you or fill in the blanks.

Questions


1.What is your blood group?

2.What is the fathers blood group?

3.In which pregnancy did your PUPPP first occur?

4.Have you had PUPPP in subsequent pregnancies?
Yes
No
No subsequent pregnancies

5.If yes, which pregnancy?

6.During which week of pregnancy did your PUPPP first appear?

7.During which Season did your PUPPP first appear?

8.How old were you when your PUPPP first appeared?

9.How much weight did you gain during your pregnancy?

10.Was Fluid Retention a problem during your pregnancy?
Yes
No

11.Who diagnosed you with PUPPP?
(Hold down the CTRL key and select all that apply.)

12.If other, who?

13.Where did the rash first occur?
(Hold down the CTRL key and select all that apply.)

14.If other, please specify.

15.When your PUPPP first occurred, were you pregnant with:

16.Prior to falling pregnant, did you have any outstanding health conditions?, Please specify

17.Did you suffer from any Allergies prior to falling pregnant?
Yes
No

18.If yes, please specify.

19.Prior to falling pregnant did you smoke?
Yes
No

20.Did you smoke through the pregnancy?
Yes
No

21.Did you consume Alcohol prior to falling pregnant?
Yes
No

22.If yes, How may standard drinks approx. per day?

23.Have you ever had Liver problems?
Yes
No

24.Did you use fertility drugs to fall pregnant?
Yes
No

25.Did you take supplements during your pregnancy?
Yes
No

26.If yes, which ones?

27.Were you induced because of your PUPPP condition?
Yes
No

28.If yes, at which week were you induced?

29.What was your babies birth weight?

30.Did your baby have any medical problems?
Yes
No

31.After giving birth, when did the RASH disappear?

32.After giving birth, when did the ITCH disappear?

33.Did you breastfeed?
Yes
No

34.How long did you breastfeed?

35.If you stopped breastfeeding while having PUPPP, do you believe that this relieved your PUPPP rash?

Diet

Please answer the following questions in relation to your diet while pregnant.


36.Did you follow a specific diet while pregnant?
(Hold down the CTRL key and select all that apply.)

37.Did you eat anything in excess while pregnant? ie. Did you crave anything in particular and eat it quite regulary? If so please provide information (eg, chocolate, ice-cream, pickles etc.)

38.Are you a diabetic?
Yes
No

39.Were you overweight before falling pregnant?
Yes
No

40.Are you intolerant to any foods?
Yes
No

41.If yes, please select
(Hold down the CTRL key and select all that apply.)

42.Would you class your diet while pregnant high in Saturated Fats?
Yes
No

43.Did you eat processed meats (salami, sandwich meat etc.) daily while pregnant?
Yes
No

44.Did you eat raw fruits and vegetables daily while pregnant?
Yes
No

45.Did you drink soda daily while pregnant? (coke, sprite, diet pepsi etc.)
Yes
No

46.Did you drink more than 2 cups of coffee daily while pregnant?
Yes
No

47.How much Alcohol did you drink while pregnant?

Conclusion


48.Please use the space below to add any additional comments about your experience with PUPPP.

49.We are hoping this questionnaire might elicit some attention from the medical community or researchers. If this happens, can we get in touch with you for further information about your PUPPP experience?
Yes
No

Please provide the following

 

First Name

 

Last Name

 

City and State

 

Phone

 

Email

 

Alternate Email

 

Country

Created by Robyn Westhoff- ©2001.