_____________________________________________________

• During one of my pregnancies I has morning sickness for at least 15 weeks.
• Toward the end of one of my pregnancies I had a lot of problems with acid stomach.
• During one my pregnancies I had problems with cramping of pre-eclampsia.
• During one of my pregnancies I had problems with feelings of numbness, lack of normal feeling in one of the limbs or other neurological complaints.
• I felt much fitter during pregnancy.
• I have had toxaemia (intoxication) during pregnancy.
• I have had diabetes during a pregnancy.
• I have had high blood pressure during a pregnancy.
• I was anaemic during or after pregnancy.
• I was depressed after a pregnancy (blue baby's).
• After a pregnancy, I gained more than 10 pounds.
• Most of my babies were born somewhat early.
• I had problems with ligaments during or after my pregnancy.
• I have had pelvic instability during or after one of my pregnancies.

• I have had .…. miscarriages.
• I have (had) ….. sons.
• I have (had) …… daughters.
• I have (had) …… brothers ………… nephews/male cousins.
• I have (had) ……. sisters …………… nieces/female cousins.
• I have had an ectopic (extra-uterine) pregnancy.
• I have polycystic ovarian syndrome (POS).
• I have had an abnormal PAP smear (PAP II, PAP IIIa, PAP IIIb or PAP IV).
• After pregnancy I have had a milky discharge from my nipples for a long time.
• I have problems with a dry vagina.
• During pregnancy I had problems with acne or lots of pimples on my back or other place.
• It has taken longer than four months to become pregnant.
• There is an autistic or MBD-child of my direct family (brother/sister/child).

_____________________________________________________