At a glance
The Pregnancy Risk Assessment Monitoring System (PRAMS) is a joint project between the state, territorial, or local health departments and the CDC's Division of Reproductive Health (DRH). In addition to the questionnaire, PRAMS also has special projects.
Overview
PRAMS Prescription Pain Reliever (Opioid) Supplement and Call-Back Survey
The PRAMS Opioid Supplement and Call-Back Survey used the existing PRAMS infrastructure to collect data on opioid use during pregnancy in 2019.
This supplement collected information on prescription opioid pain reliever use during pregnancy. It was implemented in 2019 in 32 PRAMS sites and two non-PRAMS sites using existing maternal and infant health surveys.
The PRAMS Opioid Call-Back Survey collected information about prescription opioid pain reliever use and treatment for substance use postpartum. It also gathered information on infant health from PRAMS survey respondents 9–10 months after a live birth. The Call-Back survey was implemented in seven PRAMS sites.
Analysis of PRAMS opioid supplement data found that 6.6% of women reported prescription opioid use during pregnancy.
PRAMS Data Linkage Project
DRH is working to better understand patient-centered outcomes in maternal and child health. This is a partnership of CDC and the Association of State and Territorial Health Officials (ASTHO) supported by the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE).
In 2021, Alaska, New Mexico, Texas, and Washington were selected to participate in a new learning community. In 2022, an additional eight states (Georgia, Massachusetts, Montana, Nebraska, Rhode Island, South Dakota, Tennessee, and Virginia) joined the learning community. The learning community aims to link PRAMS data to clinical or social services data. These data can include Medicaid claims, hospital discharge records, or home visiting data. The linkages support maternal and child health research to inform clinical and programmatic improvements.
PRAMS and Zika
PRAMS played a unique role in supplementing surveillance activities to address Zika virus. PRAMS activities related to Zika surveillance began in 2016 with two initiatives:
- A Zika questionnaire supplement for use by PRAMS projects in US states.
PRAMS Stillbirth Project (SOARS)
PRAMS has collected information from women with a recent live birth since inception of the project. Yet, doing so revealed a data gap related to information from women who have a pregnancy that results in a loss such as a stillbirth.
CDC funded the Utah Department of Health in 2016 and 2021 to conduct surveillance among women in the state with a recent stillbirth. Utah developed the Study of Associated Risks of Stillbirths (SOARS) survey and implemented the project in 2018 and 2021. It gathered essential data for monitoring stillbirth and related factors such as prenatal, obstetric, and postpartum health care after a pregnancy loss.
Fatherhood Surveillance
In an effort to better understand the experiences of new fathers, PRAMS completed two initiatives focusing on fathers of recently born live infants.
CDC partnered with researchers at Northwestern University and the Georgia Department of Health to look at the feasibility of conducting a PRAMS-like survey with new fathers. The PRAMS for Dads Pilot project was conducted in Georgia in 2018–2019. It used PRAMS mail and phone methodology, with the addition of web methodology, to contact fathers. Sometimes, this was in conjunction with the maternal PRAMS survey. For more information, please see article on Fathers, breastfeeding, and infant sleep practices: findings from a state-representative survey.
A Zika Postpartum Emergency Response Study was conducted using a hospital-based survey among fathers/partners of women with a recent live birth in Puerto Rico. This study was completed in December of 2017. For more information, please see the PRAMS-ZPER 2.0 survey information and Opportunities to address men's health during the perinatal period―Puerto Rico, 2017.
Both studies demonstrated the feasibility and benefits of reaching fathers shortly following the birth of their infant.
Healthy Start Evaluation Project
Beginning in 2016, 11 PRAMS sites were selected to participate in a collaborative evaluation project with the Health Resources and Services Administration (HRSA). This project evaluated the impact of the HRSA-funded Healthy Start Program. These 11 sites included Alabama, Connecticut, Georgia, Iowa, Louisiana, Massachusetts, Michigan, Missouri, New York, Oregon, and Pennsylvania.
Healthy Start Projects serve a wide range of eligible pregnant and postpartum women in selected communities within each state. For the PRAMS evaluation, selected sites agreed to oversample Healthy Start Program participants who had a live birth in their state during 2017–2018. All of the Healthy Start participants received the PRAMS survey. That way, the information they provided could be compared to that of other PRAMS participants. These data will help us understand the impact of the Healthy Start Program on maternal and infant health outcomes.