Virginia Pregnancy Risk Assessment Monitoring System (PRAMS): Overview & Initial Findings

1. Virginia Pregnancy Risk Assessment Monitoring System (PRAMS): Overview & Initial Findings Derek A. Chapman, PhD October 9, 2009

2. PRAMS Hospital Discharges Vital Records Key VDH Perinatal Health Data Sources Maternal Mortality Review

3. Principal Investigators Derek Chapman, PhD Joan Corder-Mabe, RNC, MS, WHNP Janice Hicks, PhD PRAMS Coordinator: Marilyn Wenner Statistical Analyst: Kristin Austin, MPH Lead MCH Analyst: Caroline Stampfel, MPH Data Contractor: VCU-SERL VA PRAMS Team

4. States Participating in PRAMS, 2009 WA ME MA VT SD WI MN OR WY PA NY MI DE RI NYC NE VA NJ OH MO IL UT WV MD CO TN NC Prior to 2006 NM OK AR SC Newly funded in 2006 MS AL GA LA TX AK FL HI Note: With the addition of Virginia and 8 other new states, PRAMS represents approximately 75% of all US live births

5. Why is PRAMS Important? • Collects statewide data on maternal attitudes and experiences before, during, and shortly after pregnancy • Data not available from any other source • Provides surveillance data essential for planning, implementing and evaluating MCH policies and programs • Identify groups at high risk • Monitor changes in health status • Measure progress towards goals • Plan and review programs and policies

6. Virginia PRAMS Topics • Post-pregnancy • Labor and delivery • Infant health care • Postpartum depression • Health insurance status • Post pregnancy – infant health • Preconception • Pre-pregnancy BMI • Multivitamin use • Pregnancy intention • Health insurance status • During Pregnancy • Content and source of prenatal care • Alcohol and tobacco use • Attitudes and feelings about pregnancy • Health insurance status

7. Virginia PRAMS Sampling, 2007 • Sampled approx. 100 women per month (50 LBW) • Mail survey with phone follow-up • 57% response rate (weighted)

8. VA-PRAMS Initial Findings Preconception Health

9. Preconception Multivitamin Use • “During the month before you got pregnant, how many times a week did you take a multivitamin or a prenatal vitamin?” • Analyzed 2 categories • Every day • Inadequate use (suboptimal & never took) 70% of mothers in Virginia did NOT take a multivitamin every day the month before they got pregnant

10. < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000 Inadequate Pre-pregnancy Multivitamin Use (%), Virginia PRAMS, 2007

11. Inadequate Pre-pregnancy Multivitamin Use (%) by Preconception Insurance, Virginia PRAMS, 2007

12. Pregnancy Intention • “Thinking back to just before you got pregnant with your new baby, how did you feel about becoming pregnant?” • “When you got pregnant with your new baby, were you trying to get pregnant?” 41% of mothers had an unintended pregnancy • 11% were unwanted (did not want to be pregnant) • 30% were mistimed (wanted to be pregnant later)

13. < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000 Overall Unintended Pregnancy (%) Virginia PRAMS, 2007

14. < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000 UNWANTED Pregnancy (%)Virginia PRAMS, 2007

15. < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000 MISTIMED pregnancy (%)Virginia PRAMS, 2007

16. Pregnancy Intention by Pre-pregnancy Health Insurance, Virginia PRAMS, 2007

17. What PRAMS Mothers Said… • About Pregnancy Planning • “My most recent pregnancy was unexpected and not planned. My baby was born at 23 weeks and died 7 days later.” • “I have a Master’s degree but didn’t know I needed to be taking prenatal vitamins before I got pregnant. I only wish I had been…our baby was born with a NTD. This information may need to be emphasized to women.”

18. VA-PRAMS Initial Findings During Pregnancy

19. Smoking in the 3rd Trimester • Screener: “Have you smoked at least 100 cigarettes in the past 2 years?” • “In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day?” 11% of mothers in Virginia reported smoking in the 3rd trimester of pregnancy

20. < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000 Maternal Smoking in the 3rd Trimester (%)Virginia PRAMS, 2007

21. Maternal Smoking in the 3rd Trimester (%)by Prenatal Insurance StatusVirginia PRAMS, 2007

22. What PRAMS Mothers Said… • About Risk Behaviors • “I wish that my physician and/or other nurses had given me additional resources on how to quit smoking.” • “I found it very sad that I saw many full term pregnant women hooked to IVs being pushed outside in wheelchairs to smoke.” • “I know people who do drugs excessively while pregnant.”

23. VA-PRAMS Initial Findings Post-Birth

24. Infant Sleep Position • “How do you most often lay your baby down to sleep now?” 69% of mothers most often lay their baby down to sleep on his or her back

25. Mothers Primarily Using the BACK Sleep Position (%), VA PRAMS, 2007 < 12 years 12 years >12 years non-Hispanic Black Hispanic non-Hispanic White < 20 20-24 25-29 30+ <$20,000 $20,000-$34,999 >$35,000

26. Mothers Primarily Using the BACK Sleep Position (%) by Insurance StatusVA PRAMS, 2007

27. Thank You! Any questions? PRAMS Website: http://www.vahealth.org/prams/ Derek Chapman, PhD Derek.Chapman@vdh.virginia.gov