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

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Pregnancy risk assessment monitoring system prams

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


Prams overview

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


Prams background and goals

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


Who participates in the prams surveys

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)


Prams participation 2012

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


Prams surveys

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


Prams questionnaire cycle

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


Prams bread butter

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


Prams phase 6 priority topics

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)


Prams scientific work group

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


Prams use past present and future

PRAMS use: past, present and future

  • Special populations


South dakota tribal pregnancy risk assessment monitoring system

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


Prams use past present and future1

PRAMS use: past, present and future

  • Special populations

  • Emerging health issues and priority topics


Prams influenza questionnaire supplement

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


Prams use past past present and future

PRAMS use: past, past, present and future

  • Special populations

  • Emerging health issues and priority topics

  • Program evaluation


Prams wkkf kellogg foundation partnership

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


Prams use past present and future2

PRAMS use: past, present and future

  • Special populations

  • Emerging health issues and priority topics

  • Program evaluation

  • Chronic disease prevention


Prams and chronic disease prevention

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


Chronic disease related topics in prams

Chronic Disease Related Topicsin PRAMS


Prams use past present and future3

PRAMS use: past, present and future

  • Special populations

  • Emerging health issues and priority topics

  • Program evaluation

  • Chronic disease prevention

  • Data linkages


Data linkages

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


Prams use past present and future4

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


Customer satisfaction

Customer Satisfaction


Pregnancy risk assessment monitoring system prams

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


Thank you

Thank you !

www.cdc.gov/prams/


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