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Virginia Pregnancy Risk Assessment Monitoring System (PRAMS): Overview & Initial Findings. Derek A. Chapman, PhD October 9, 2009. PRAMS. Hospital Discharges. Vital Records. Key VDH Perinatal Health Data Sources. Maternal Mortality Review. Principal Investigators Derek Chapman, PhD

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

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Virginia pregnancy risk assessment monitoring system prams overview initial findings l.jpg

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

Derek A. Chapman, PhD

October 9, 2009


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PRAMS

Hospital Discharges

Vital Records

Key VDH Perinatal Health Data Sources

Maternal Mortality Review


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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


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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


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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


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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


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Virginia PRAMS Sampling, 2007

  • Sampled approx. 100 women per month (50 LBW)

  • Mail survey with phone follow-up

  • 57% response rate (weighted)


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VA-PRAMS Initial Findings

Preconception Health


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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


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< 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


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


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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)


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< 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


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< 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


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< 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


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


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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.”


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VA-PRAMS Initial Findings

During Pregnancy


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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


Maternal smoking in the 3 rd trimester virginia prams 2007 l.jpg

< 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


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


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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.”


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VA-PRAMS Initial Findings

Post-Birth


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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


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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


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


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Thank You!

Any questions?

PRAMS Website:

http://www.vahealth.org/prams/

Derek Chapman, PhD

[email protected]


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