Fetal Alcohol Syndrome

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Assessment of Smoking Exposure Prior to Pregnancy

Please complete the fields below to determine exposure parameters during pregnancy.

On average how many days per week do you smoke?

On an average day how many cigarettes do you smoke?

How many days have you smoked 10 or more cigarettes in the last month?

What is the most cigarettes you smoked on any one day in the last month?

Estimated Exposure Parameters:

      Smoking Days
                               (Estimated number of smoking days during a pregnancy)

      Percent of Days Exposed During Pregnancy
                               (Estimated days exposed during a pregnancy)

      Number of Cigarettes during Pregnancy
                               (Estimated number of cigarettes during a pregnancy)

      Number of packs
                               (Estimated cumulative exposure in packs during a pregnancy)

Questions? Send them to Laburd@medicine.nodak.edu.