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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. Describe PRAMS in terms of its objectives and methods

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

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  1. Maternal Experiences Before, During, and After Pregnancy: Findings from PRAMS MCH Epidemiology Annual Conference December 10, 2003 2:00 – 3:30pm

  2. 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

  3. 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

  4. 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

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

  6. 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

  7. 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)

  8. 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

  9. Preliminary 2001 findings from PRAMS

  10. 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

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

  12. 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

  13. Unintended Pregnancy Among Women Delivering a Live Infant, PRAMS 2001 Range: 36.7 – 48.9

  14. Unintended Pregnancy Among Women Delivering a Live Infant, PRAMS 1996-2001 • No statistically significant change over time

  15. 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

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

  17. 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

  18. Entry into Prenatal Care after the 1st trimester • Mother reported starting prenatal care more than 12 weeks or 3 months into her pregnancy

  19. Entry into Prenatal Care after the 1st trimester, PRAMS 2001 Range: 16.5 – 28.2

  20. Entry into Prenatal Care after the 1st trimester, PRAMS 1996-2001 • No statistically significant change over time X Significant decrease over time

  21. Infant Sleep Position on Back • “How do you most often lay your baby down to sleep?”

  22. Infant Sleep Position on Back, PRAMS 2001 Range: 47.9- 76.9

  23. Infant Sleep Position on Back,PRAMS 1996-2001 • Statistically significant change over time

  24. 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

  25. 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

  26. Pregnancy-Related Complications, PRAMS 2000-2001 Range 2000: 9.2 – 13.4 Range 2001: 10.5 – 15.3

  27. 1st Week Infant Checkup • Infant seen by a doctor, nurse, or other health care provider in the first week after leaving the hospital

  28. First Week Infant Checkup, PRAMS 2000-2001 Range 2000: 65.7 – 88.6 Range 2001: 64.6 – 88.0

  29. 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)

  30. Postpartum Contraceptive Use, PRAMS 2000-2001 Range 2000: 77.9 – 89.9 Range 2001: 78.6 – 90.1

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

  32. Multivitamin Use, PRAMS 2000-2001 Range 2000: 25.9 – 40.7 Range 2001: 26.4 – 42.3

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

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