Pregnancy Risk Assessment Monitoring System (PRAMS)

1. Pregnancy Risk Assessment Monitoring System (PRAMS) CAPT Wanda Barfield MD, MPH Director, Division of Reproductive HealthNational Center for Chronic Disease Prevention and Health Promotion Secretary’s Advisory Committee on Infant MortalityNovember 14, 2012

2. PRAMS Overview • Population-based surveillance system • Self-reported maternal behaviors and experiences around the time of pregnancy • Supplements birth certificate information • State and near-national estimates

3. PRAMS Background and Goals • Established in 1987 as part of an Infant Health Initiative • Congressional funding provided to CDC to establish state-based programs • Reduce maternal and infant morbidity and mortality • Maternal and infant health programs • Health policies • Maternal behaviors

4. Who Participates in the PRAMS Surveys? • Women who recently delivered a live infant • Random sample from birth certificate records • Women are sampled when infants are 2 - 6 months old • State sample ~1500–3000 women per year • 40 states and NYC (combined annual sample ~ 77,000)

5. PRAMS Participation, 2012 WA ME VT MN OR NY MI RI NYC NE NJ OH IL UT WV CO MD NC NM OK AR SC MS AL GA LA TX AK FL HI NH MA WI CT WY IA PA DE VA MO TN PRAMS represents approximately 78% of all U.S. live births

6. PRAMS Surveys • Data collection primarily by mailed paper survey • Survey booklets are 14 pages and around 85 questions in length • Telephone follow-up • Takes 20 - 30 minutes to complete

7. PRAMS Questionnaire Cycle • PRAMS collects data in phases • Corresponds to questionnaire revision length and time in the field • Phases usually last 3-5 years • Affected by various factors such as funding new sites, launching new data collection systems, or plans to do quality assessment • Phase 6 data for 2009 – 2010 are currently available for analysis • Phase 7 data for 2012 are currently being collected

8. PRAMS Bread & Butter • Key long-term PRAMS topics • Adequacy, barriers, and content of PNC • Breastfeeding • Contraceptive Use • Infant Sleep Position • Medicaid and WIC participation • Physical Abuse • Unintended Pregnancy • Data going back to 1988 for some states

9. PRAMS Phase 6 Priority Topics • New topics for Phase 6 • Cesarean section/labor induction (non-core) • Chronic Disease • Health Insurance • Infant 1-Week Check-Up • Influenza Vaccination (non-core) • Obesity • Preconception Health • Postpartum Depression • Data currently available (2009 – 2010)

10. PRAMS Scientific Work Group • First meeting on October 25, 2012 • Multi-disciplinary group of specialists in MCH, chronic disease, public health, survey methods and clinical practice • Purpose is to provide guidance to PRAMS on: • Ensuring that PRAMS data maintain high quality to impact policy and programmatic efforts • Crafting new questions given renewed focus on science translation and possible use of PRAMS for quality assessment • Generating constant and greater awareness of PRAMS and its value

11. PRAMS use: past, present and future • Special populations

12. South Dakota Tribal Pregnancy Risk Assessment Monitoring System • The South Dakota Tribal Pregnancy Risk Assessment Monitoring System known as SD Tribal PRAMS was: • led by the Yankton Sioux Tribe, • managed by the Northern Plains Tribal Epidemiology Center (NPTEC) of the Aberdeen Area Tribal Chairmen’s Health Board (AATCHB), • funded through a cooperative agreement with the Centers for Disease Control and Prevention and additional financial support from the Indian Health Service • implemented in collaboration with all South Dakota tribes, the South Dakota and North Dakota Departments of Health • This survey conducted in 2007 addressed the experiences and behaviors before, during, and after the most recent births of women from South Dakota • South Dakota Tribal PRAMS Statewide Surveillance Report provided information on findings from the questionnaire conducted between June and November 2007

13. PRAMS use: past, present and future • Special populations • Emerging health issues and priority topics

14. PRAMS Influenza Questionnaire Supplement • H1N1 Flu Pandemic: • Little data on seasonal influenza vaccine coverage among pregnant women • Pregnant women priority group for H1N1 vaccination • Partners • EOC H1N1 Vaccine Task Force • CDC Immunization Services Division • PRAMS sites • Funding • For supplemental question implementation by states (2009-2010 flu season) • For support of CDC & state dissemination activities

15. PRAMS use: past, past, present and future • Special populations • Emerging health issues and priority topics • Program evaluation

16. PRAMS-WKKF Kellogg Foundation Partnership • Kellogg Programming in LA, MI, MS, NM & data needed: • Focus on vulnerable populations (minority, low income, children) • Enrollment in WIC and Medicaid • Breastfeeding rates and exposure to baby friendly practices • Home visitations including access to prenatal care • Medical Home • PRAMS CDC & State partners: • Modified state sampling • Modified PRAMS questionnaire to capture target indicators • Develop new community partnerships to increase visibility & use of data • Develop and test new data collection methods to increase response rates • Analyze data for Kellogg program evaluation use

17. PRAMS use: past, present and future • Special populations • Emerging health issues and priority topics • Program evaluation • Chronic disease prevention

18. PRAMS and Chronic disease prevention PRAMS data can monitor and evaluate screening and diagnosis of chronic disease conditions among women of reproductive age during: • Preconception • Pregnancy • Postpartum • Inter-conception

19. Chronic Disease Related Topicsin PRAMS

20. PRAMS use: past, present and future • Special populations • Emerging health issues and priority topics • Program evaluation • Chronic disease prevention • Data linkages

21. Data Linkages Newborn Screening PRAMS ART Live Birth Certificates Birth Defects Hospital Discharge Medicaid WIC Infant Deaths SIDS/SUID Registry Direct linkages Live birth certificates – intermediate files Indirect linkages ART: Assisted Reproductive Technology WIC: Special Supplemental Nutrition Program for Women, Infants and Children Grigorescu V, Kleyn MJ, KorzeniewskiSJet al. Am J Prev Med 2010;38(4S):S522–S527

22. PRAMS use: past, present and future • Special populations • Emerging health issues and priority topics • Program evaluation • Chronic disease prevention • Data linkages • Service quality and satisfaction

23. Customer Satisfaction

24. Division of Reproductive Health Organizational Chart, October 2012 Associate Director Global Health Howie Goldberg Office of the Director Wanda Barfield, Director Dee Wetterhall, Deputy Director Associate Director Science Lee Warner Associate Director Policy, Partnership, and Communication Linda West Maternal and Infant Health Branch William Callaghan, Chief Martha Boisseau, Deputy Chief Carrie Shapiro-Mendoza, Senior Scientist Women’s Health and Fertility Branch Denise Jamieson, Chief Sandra Gambescia, Deputy Chief Suzanne Folger, Senior Scientist Applied Sciences Branch Violanda Grigorescu, Chief Brenda Reed, Deputy Chief Deborah Dee, Senior Scientist • Teams • Adolescent Reproductive Health • Maternal Child Health Epidemiology • Pregnancy Risk Assessment Monitoring System (PRAMS) • Teams • Assisted Reproductive Technology • Fertility Epidemiology Studies • Unintended Pregnancy STD/HIV Intervention Research • Teams • Infant Health • Maternal Health • Reproductive Health & Chronic • Disease Prevention

25. Thank you ! www.cdc.gov/prams/