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PRAMS: A Tool to Understanding and Addressing Prematurity

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Title: 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

2
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.

3
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.

4
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).

5
State Participation in PRAMS 2004
VT
RI
NYC
NJ
DE
MD
HI
http//www.cdc.gov/reproductivehealth/pramstates.h
tm
6
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
7
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
8
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

9
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

10
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

11
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

12
Factors Associated with Prematurity
  • Physiologic
  • Placental insufficiency
  • Genital tract infections
  • Hemorrhage or abruptio placenta
  • Incompetent cervix
  • Diabetes
  • Hypertension

13
Factors Associated with Prematurity (cont.)
  • Social stressors
  • Depression
  • Domestic violence
  • Psychiatric disorder
  • Homelessness (and multiple residences)
  • Substance use
  • Tobacco
  • Alcohol
  • other drugs
  • Multiple births

14
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

15
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

16
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

17
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

18
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

19
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

20
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.
21
Pregnancy Intention National
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
22
Late or No Entry to PNC
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
23
Domestic Violence by Partner During Pregnancy
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
24
Change in Alcohol Use
Montana 62.8 Before 6.7 During
PRAMS 1999 Surveillance Report, CDC Montana
2002 PRAMS Data
25
Alcohol Use in 3 Months Before Pregnancy
None 18
Any 82
All MT Mothers
26
Alcohol Use 3 Months Before Pregnancy by Mothers
Education Level
84
83
76
27
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
28
Smoking Do You Smoke Now?
Yes 21
Yes 43
No 23
No 57
No 79
Yes 76
All MT Mothers
MT Mothers lt20
29
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 406-444-4743
  • FAX 406-444-2606
  • E-mail jdotson_at_mt.gov
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