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Maternal Experiences Before, During, and After Pregnancy: Findings from PRAMS. MCH Epidemiology Annual Conference December 10, 2003 2:00 – 3:30pm. Session Objectives. Describe PRAMS in terms of its objectives and methods

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maternal experiences before during and after pregnancy findings from prams

Maternal Experiences Before, During, and After Pregnancy: Findings from PRAMS

MCH Epidemiology Annual Conference

December 10, 2003

2:00 – 3:30pm

session objectives
Session Objectives
  • Describe PRAMS in terms of its objectives and methods
  • Identify key issues in the analysis of maternal morbidity data and pregnancy intention
  • List maternal behaviors that are important for program planning and evaluation and policy formulation at the state level
findings from the pregnancy risk assessment monitoring system prams 1996 2001

Findings from the Pregnancy Risk Assessment Monitoring System (PRAMS), 1996-2001

Denise D’Angelo, Kristen Helms, Letitia Williams, Laurie F. Beck, Christopher H. Johnson, Amy Lansky, Leslie E. Lipscomb, Brian Morrow, Nedra Whitehead, The PRAMS Working Group

acknowledgments the prams working group

Acknowledgments -The PRAMS Working Group

Alabama - Rhonda Stephens, MPH; Alaska - Kathy Perham-Hester, MS, MPH; Arkansas - Gina Redford, MAP; Colorado - Alyson Shupe, PhD; Florida - Helen Marshall; Georgia - Carol Hoban; Hawaii - Limin Song, MPH, CHES; Illinois - Theresa Sandidge, MA; Louisiana - Joan Wightkin; Maine - Martha Henson; Maryland - Diana Cheng, MD; Michigan - Yasmina Bouraoui, MPH; Minnesota - Jan Jernell; Mississippi - Linda Pendleton, LMSW; Montana - JoAnn Dotson; Nebraska - Jennifer Severe-Oforah; New Jersey - Lakota Kruse, MD; New Mexico - Ssu Weng, MD, MPH; New York State - Anne Radigan-Garcia; New York City - Candace Mulready, MPH; North Carolina - Paul Buescher, PhD; North Dakota - Sandra Anseth, RN; Ohio - Amy Davis; Oklahoma –Dick Lorenz; Oregon - Ken Rosenberg, MD, MPH; Rhode Island - Sam Viner-Brown; South Carolina - Sylvia Sievers; Texas - Tanya J. Guthrie, PhD; Utah - Lois Bloebaum; Vermont - Peggy Brozicevic; Washington - Linda Lohdefinck; West Virginia - Melissa Baker, MA; CDC PRAMS Team

overview
Overview
  • Describe PRAMS
  • Discuss Surveillance Report series
  • Present preliminary results for selected PRAMS states
    • 2001 prevalence estimates
    • Trends (1996-2001)
what is prams
What is PRAMS?
  • Ongoing, population-based, state-based surveillance of women delivering live infants
  • Self-reported data on maternal behaviors and experiences before, during, and after pregnancy
prams methodology
PRAMS Methodology
  • Stratified sample drawn from birth certificate records 2-6 months after delivery
  • Standardized data collection protocol
  • Mixed-mode data collection (mail and telephone)
cdc and prams data
CDC and PRAMS Data
  • PRAMS Surveillance Reports
    • Reports available since 1995
    • 2000 and 2001 in progress
    • Over 20 indicators reported in each
    • Current year prevalence data by state and sociodemographic characteristics
    • Trend data reported by state
  • MMWR Surveillance Summaries
    • Reports done for 1997, 1999, 2000
  • All reports available on the PRAMS website http://www.cdc.gov/reproductivehealth/srv_prams.htm
states participating in prams 2001

WA

ME

MT

ND

VT

OR

MN

NY

MI

RI

NYC

NE

NJ

OH

DE

IL

UT

MD

CO

WV

NC

NM

OK

AR

SC

MS

AL

GA

LA

TX

AK

FL

HI

States Participating in PRAMS, 2001

States with data presented

All PRAMS States in 2001

data analysis
Data Analysis
  • 2001 prevalence estimates by state
  • Trend data from 1996-2001 for those states with at least three years of data
unintended pregnancy among women delivering a live infant
Unintended Pregnancy Among Women Delivering a Live Infant
  • Mistimed or unwanted at the time of conception
    • Mistimed = wanted pregnancy later
    • Unwanted = did not want pregnancy then or at any time in the future
unintended pregnancy among women delivering a live infant prams 1996 2001
Unintended Pregnancy Among Women Delivering a Live Infant, PRAMS 1996-2001
  • No statistically significant change over time
physical abuse during pregnancy
Physical Abuse During Pregnancy
  • Pushing, hitting, slapping, kicking, choking, or any other way of physically hurting
  • By husband or partner
  • At any time during pregnancy
physical abuse during pregnancy prams 2001
Physical Abuse During Pregnancy,PRAMS 2001

Range: 2.6 – 5.8

HP 2010 goal 3.3 per 1000

physical abuse during pregnancy prams 1996 2001
Physical Abuse During Pregnancy,PRAMS 1996-2001
  • No statistically significant change over time, but 2 states show decrease in 2001, and 5 states show an increase
entry into prenatal care after the 1 st trimester
Entry into Prenatal Care after the 1st trimester
  • Mother reported starting prenatal care more than 12 weeks or 3 months into her pregnancy
entry into prenatal care after the 1 st trimester prams 1996 2001
Entry into Prenatal Care after the 1st trimester, PRAMS 1996-2001
  • No statistically significant change over time

X Significant decrease over time

infant sleep position on back
Infant Sleep Position on Back
  • “How do you most often lay your baby down to sleep?”
infant sleep position on back prams 1996 2001
Infant Sleep Position on Back,PRAMS 1996-2001
  • Statistically significant change over time
new indicators for 2000 2001
New Indicators for 2000-2001
  • Phase IV Survey implemented with January 2000 births (will be used through January 2004 births)
  • Several new indicators added:
    • Pregnancy-related complications resulting in a hospital stay
    • Infant 1st week checkup
    • Postpartum contraceptive use
    • Multivitamin Use
pregnancy related complications
Pregnancy-Related Complications
  • Possible complications:
    • Early labor pains
    • High blood pressure
    • Vaginal bleeding
    • Placenta problems
    • Severe nausea, vomiting, dehydration
    • High blood sugar
    • UTI
    • PROM
    • Incompetent cervix
  • Any complication requiring a hospital stay of at least one day
pregnancy related complications prams 2000 2001
Pregnancy-Related Complications, PRAMS 2000-2001

Range 2000: 9.2 – 13.4

Range 2001: 10.5 – 15.3

1 st week infant checkup
1st Week Infant Checkup
  • Infant seen by a doctor, nurse, or other health care provider in the first week after leaving the hospital
first week infant checkup prams 2000 2001
First Week Infant Checkup, PRAMS 2000-2001

Range 2000: 65.7 – 88.6

Range 2001: 64.6 – 88.0

postpartum contraceptive use
Postpartum Contraceptive Use
  • Mother reporting “yes” to the questions, “Are you and your husband or partner doing anything now to keep from getting pregnant?”
  • Now = at time of survey (2-6 months postpartum)
postpartum contraceptive use prams 2000 2001
Postpartum Contraceptive Use, PRAMS 2000-2001

Range 2000: 77.9 – 89.9

Range 2001: 78.6 – 90.1

folic acid intake
Folic Acid Intake
  • Multivitamin consumption (as a measure of folic acid use) four or more times per week during the month prior to pregnancy
multivitamin use prams 2000 2001
Multivitamin Use, PRAMS 2000-2001

Range 2000: 25.9 – 40.7

Range 2001: 26.4 – 42.3

conclusions
Conclusions
  • Value of state-based data
    • Progress toward Healthy People objectives and Title V performance measures
    • Program planning
    • Policy decisions