1. Do you feel like you have no energy or don’t enjoy doing the things you once enjoyed?
A. Not really
B. Sometimes
C. Yes
2. Do you feel just as bad, even when people try to reassure you that you are going to be fine and you are going to be a good parent?
A. Not really
B. Sometimes
C. Yes
3. Do you have excessive thoughts of anxiety or fear about your pregnancy and your baby?
A. Not really
B. Sometimes
C. Yes
4. Do you struggle with low self-esteem, feeling inadequate, or fears that you are not going to be a good parent?
A. Not really
B. Sometimes
C. Yes
5. Do you ever have thoughts of suicide or harming yourself?
A. No
B. Sometimes
C. Yes
6. Have there been significant changes in your appetite, or have you experienced significant trouble in gaining weight during your pregnancy?
A. No
B. Sometimes
C. Yes
7. Have you been using any drugs, alcohol, or nicotine during your pregnancy?
A. No
B. Sometimes
C. Yes
8. Do you struggle to keep up with appropriate prenatal care?
A. Not really
B. Sometimes
C. Yes
9. Do you have a history of depression, anxiety, or other mood disorders?
A. Not really
B. Sometimes
C. Yes
10. Have you been experiencing sleep disturbances, either not being able to get enough sleep or sleeping too much?
A. Not really
B. Sometimes
C. Yes
