PRAMS: A Tool to Understanding and Addressing Prematurity

1
PRAMS A Tool to Understanding and Addressing
Prematurity

• Jo Ann Walsh Dotson RN MSN
• Montana DPHHS Helena, MT
• And
• Nan Streeter RN MS
• Utah DOH Salt Lake City, UT

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What is PRAMS?

• PRAMS stands for Pregnancy Risk Assessment
  Monitoring System.
• PRAMS is a surveillance project of the Centers
  for Disease Control and Prevention (CDC) and
  state health departments.
• PRAMS collects state-specific, population-based
  data on maternal attitudes and
• experiences prior to, during, and
• immediately following pregnancy.

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Background of PRAMS

• Initiated in 1987
• Infant mortality rates were no longer declining
  as rapidly as they had in prior years.
• incidence of low-birth-weight infants had changed
  little in the previous 20  years.
• Goal of PRAMS project is to improve the health of
  mothers and infants by reducing adverse outcomes
  such as low birth weight, infant mortality and
  morbidity, and maternal morbidity.
• PRAMS provides state-specific data for
• planning and assessing health programs.

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Importance of PRAMS

• The PRAMS sample is chosen from all women who had
  a live birth recently, so findings can be applied
  to the state's entire population of women who
  have recently delivered a live born infant.
• PRAMS allows CDC and the states to monitor
  changes in maternal and child health indicators
  (e.g., unintended pregnancy, prenatal care,
  breast-feeding, smoking, drinking, infant
  health).

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State Participation in PRAMS 2004
VT
RI
NYC
NJ
DE
MD
HI
http//www.cdc.gov/reproductivehealth/pramstates.h
tm
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Type of PRAMS publication, CDC PRAMS publication
database, 1988-Oct 2004
Rochat, Roger Scientific Writing with PRAMS
Presented at the Annual PRAMS conference
December 7, 2004/Atlanta, GA
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Frequency of reporting on 18 topics based on
PRAMS data, 1988-Oct 2004
Rochat, Roger Scientific Writing with PRAMS
Presented at the Annual PRAMS conference
December 7, 2004/Atlanta, GA
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PRAMS Process

• Survey of women with live born infants in
  previous 12 months
• Standardized core questions with state option
  of additional questions.
• Sample is drawn from birth certificates using a
  stratified random sampling technique
• Stratification most frequently includes
  birthweight, maternal race/ethnicity, maternal
  education, maternal age, geographic area or
  Medicaid status

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Data Collection

• Mixed mode
• Mailed self administered
• Follow up with telephone survey if unsuccessful
  mail response
• Self reported survey data linked to selected
  birth certificate data

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PRAMS Core Question Topic Areas

• Attitudes and feelings about most recent
  pregnancy
• Content and source of prenatal care
• Substance use tobacco and alcohol

• Pregnancy-related morbidity
• Infant health care
• Maternal living conditions
• Mothers knowledge of pregnancy related
• health issues

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Prematurity in the U.S.

• Prematurity defined as birth prior to 37th
  completed week of gestation
• Increased by 20 in the last decade
• Accounts for 11 of all births in U.S.
• 2/3 of infant deaths in U.S. occurred in infants
  who were LBW or preterm
• A preterm infant costs 13 times the cost of a
  full term newborn

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Factors Associated with Prematurity

• Physiologic
• Placental insufficiency
• Genital tract infections
• Hemorrhage or abruptio placenta
• Incompetent cervix
• Diabetes
• Hypertension

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Factors Associated with Prematurity (cont.)

• Social stressors
• Depression
• Domestic violence
• Psychiatric disorder
• Homelessness (and multiple residences)
• Substance use
• Tobacco
• Alcohol
• other drugs
• Multiple births

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Purpose/Uses of PRAMS r/t Prematurity

• PRAMS may be used to inform policy makers about
• The incidence of risk factors in their states
• Characteristics of women with specific risk
  factors
• Geographic/demographic clues to risk factors
• Knowledge deficits existing in pregnant woman
  which may be addressed, potentially impacting
  prematurity
• Successes (or failures) of efforts in the state
  to address risk factors

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Analysis

• Basic
• Valuable information regarding comparative
  incidence
• Direct more in depth analysis
• Useful in legislative analysis

• Complex (Logistic Regression)
• Informs association and related instances
• Maternal Age
• Cigarette use
• Related to
• Prematurity incidence

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Cigarette Smoking During PregnancyMMWR, 1999

• Purpose Determine the incidence and impact of
  smoking during pregnancy
• Sample Maine (10,770 women)
• Findings
• Smoking during last months of pregnancy decrease
  in women 20 and over
• Women less than 20 did not have a
• significant decrease in incidence of
• smoking

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Relationship Between Maternal Behaviors and Birth
OutcomesBeck et al., 2002

• Purpose Examine impact of behaviors and
  socioeconomic indicators on outcomes
• Sample 17 states
• Findings
• Intendeness ranged from 33.7 52
• Late or no PNC 16.1 29.9
• Smoking from 6.2 27.2
• Physical abuse from 2.1 6.3
• Breast feeding initiation 48 89
• Breastfeeding duration from 34.9 78.1

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Prevalence and Patterns of Physical Abuse Before,
During and After PregnancyMartin, Mackie,
Kupper, Buescher Moracco, 2001

• Purpose Incidence of physical abuse around
  pregnancy
• Sample North Carolina (2,648 women)
• Findings

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Montana PRAMS

• Mothers who had a Live Birth in Montana within
  the Last Year
• No spontaneous / intended abortions
• No stillbirths
• No Montana mothers who had their babies outside
  of Montana
• Point in Time Survey

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Point in Time Projects

• Created by CDC to support rural/frontier efforts
  to initiate new mother surveys
• Year One Planning
• Year Two Data Collection
• Year Three Analysis and Report Development
• Evaluate process and potential

Jo Ann Dotson, Montana PRAMS Project, A Point in
Time December 2002.
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Pregnancy Intention National
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
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Late or No Entry to PNC
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
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Domestic Violence by Partner During Pregnancy
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
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Change in Alcohol Use
Montana 62.8 Before 6.7 During
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
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Alcohol Use in 3 Months Before Pregnancy
None 18
Any 82
All MT Mothers
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Alcohol Use 3 Months Before Pregnancy by Mothers
Education Level
84
83
76
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Change in Smoking from Before Pregnancy to
During Pregnancy
Montana 28.5 Before 15.6 During
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
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Smoking Do You Smoke Now?
Yes 21
Yes 43
No 23
No 57
No 79
Yes 76
All MT Mothers
MT Mothers lt20
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Speaker Contact Info

• Jo Ann Walsh Dotson, R.N., M.S.N.
• Chief, Family and Community Health Bureau
• Montana Department of Public Health and Human
  Services
• 1400 Broadway PO Box 202951
• Helena MT 59620
• Phone [phone]
• FAX [phone]
• E-mail jdotson_at_mt.gov