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

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

• MCH Epidemiology Annual Conference
• December 10, 2003
• 200 330pm

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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

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

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

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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

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Overview

• Describe PRAMS
• Discuss Surveillance Report series
• Present preliminary results for selected PRAMS
  states
• 2001 prevalence estimates
• Trends (1996-2001)

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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

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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)

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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.ht
  m

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Preliminary 2001 findings from PRAMS
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States Participating in PRAMS, 2001
States with data presented
All PRAMS States in 2001
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Data Analysis

• 2001 prevalence estimates by state
• Trend data from 1996-2001 for those states with
  at least three years of data

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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

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Unintended Pregnancy Among Women Delivering a
Live Infant, PRAMS 2001
Range 36.7 48.9
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Unintended Pregnancy Among Women Delivering a
Live Infant, PRAMS 1996-2001

• No statistically significant change over time

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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

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Physical Abuse During Pregnancy,PRAMS 2001
Range 2.6 5.8
HP 2010 goal 3.3 per 1000
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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

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Entry into Prenatal Care after the 1st trimester

• Mother reported starting prenatal care more than
  12 weeks or 3 months into her pregnancy

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Entry into Prenatal Care after the 1st trimester,
PRAMS 2001
Range 16.5 28.2
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Entry into Prenatal Care after the 1st trimester,
PRAMS 1996-2001

• No statistically significant change over time
• X Significant decrease over time

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Infant Sleep Position on Back

• How do you most often lay your baby down to
  sleep?

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Infant Sleep Position on Back, PRAMS 2001
Range 47.9- 76.9
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Infant Sleep Position on Back,PRAMS 1996-2001

• Statistically significant change over time

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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

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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

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Pregnancy-Related Complications, PRAMS 2000-2001
Range 2000 9.2 13.4 Range 2001 10.5 15.3
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1st Week Infant Checkup

• Infant seen by a doctor, nurse, or other health
  care provider in the first week after leaving the
  hospital

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First Week Infant Checkup, PRAMS 2000-2001
Range 2000 65.7 88.6 Range 2001 64.6 88.0
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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)

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Postpartum Contraceptive Use, PRAMS 2000-2001
Range 2000 77.9 89.9 Range 2001 78.6 90.1
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Folic Acid Intake

• Multivitamin consumption (as a measure of folic
  acid use) four or more times per week during the
  month prior to pregnancy

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Multivitamin Use, PRAMS 2000-2001
Range 2000 25.9 40.7 Range 2001 26.4 42.3
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Conclusions

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