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* 1. What is your first name?

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* 2. In what year were you born? (Enter 4-digit birth year; for example, 1976.)

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* 3. How many months ago was your most recent pregnancy?

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* 4. What number pregnancy was this for you?

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* 6. For how many months had you followed this diet continuously prior to giving birth?

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* 8. If you took cod liver oil, what brand was it?

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* 9. If you took cod liver oil, how much did you take per day?

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* 10. If you took cod liver oil, how many months had you been taking it prior to giving birth?

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* 12. If you took fish oil, what brand was it?

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* 13. If you took fish oil, how much did you take per day?

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* 14. If you took fish oil, how many months had you been taking it prior to giving birth?

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* 15. Please list any other supplements you took during your pregnancy, and include the brand, dose, and length of time using the supplement prior to birth. If you did not take any other supplements, please write "none."

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* 22. If you ate cheese, what were the most common types?

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* 25. How many hours were you in labor?

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* 27. If your baby was given an Apgar score, what was it?

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* 28. What was your baby's birth weight?

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* 29. What was your baby's birth length?

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* 30. Did you experience any of the following or any other complications in association with your pregnancy?

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* 31. Were you administered any of the following medications at or near the time of birth?

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* 32. Please tell us anything else would like to share about your pregnancy.

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* 33. Would it be alright to contact you with followup questions? If so, please enter your email address.

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