PRAMS Special Projects
The Pregnancy Risk Assessment Monitoring System (PRAMS) Opioid Supplement and Call-Back Survey used the existing PRAMS infrastructure to collect data on opioid use and misuse around the time of pregnancy in 2019. The PRAMS Prescription Opioid Supplement collects information on prescription opioid pain reliever use during pregnancy. The Prescription Opioid Supplement 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 collects information about prescription opioid pain reliever use and treatment postpartum, as well as infant health from PRAMS survey respondents 9-10 months after a live birth. The Call-back survey was implemented in seven PRAMS sites.
Data from these surveys will help state, local and territorial health departments, clinical health providers, CDC, and other federal agencies develop programs and policies to ensure access to recommended clinical care.
CDC’s Division of Reproductive Health (DRH), with support from the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), is working in partnership with the Association of State and Territorial Health Officials (ASTHO) to better understand patient-centered outcomes in maternal and child health. Alaska, New Mexico, Texas, and Washington have been selected to participate in a new learning community aimed at linking Pregnancy Risk Assessment Monitoring System (PRAMS) data to clinical or social services data, such as Medicaid claims, hospital discharge records or home visiting data. These linkages support maternal and child health Patient-Centered Outcomes Research to inform clinical and programmatic improvement initiatives that help patients and those who support them communicate and make informed healthcare decisions.
The Pregnancy Risk Assessment Monitoring System (PRAMS) has played a unique role in supplementing surveillance activities related to Zika virus awareness and prevention around the time or pregnancy in US states and Puerto Rico. PRAMS activities related to Zika surveillance began in 2016 with two initiatives: 1) a questionnaire supplement for use by PRAMS projects in US states, and 2) a special PRAMS Zika Postpartum Emergency Response (ZPER) project in Puerto Rico. Learn more: Women’s Awareness and Healthcare Provider Discussions and Zika Virus During Pregnancy, United States, 2016-2017 [PDF – 326 KB].
PRAMS has collected information from women with a recent live birth since inception of the project, but in doing so encounters a data gap related to information from women who have a pregnancy that results in a loss such as a stillbirth.
CDC PRAMS funded the Utah Department of Health in 2016 to use a Stillbirth Model Protocol in their state. Utah developed the Study of Associated Risks of Stillbirths (SOARS) survey and implemented the project in 2018 to gather essential data for monitoring stillbirth and related factors such as prenatal, obstetric and postpartum health care after a pregnancy loss.
Though PRAMS historically has only surveyed mothers, the important role that men can play in improving reproductive health within their families is being increasingly recognized. In an effort to better understand the experiences of new fathers, PRAMS completed 2 initiatives targeting fathers of recently born live infants.
- CDC’s Division of Reproductive Health has been partnering with researchers at Northwestern University and the Georgia Department of Health to conduct formative research on the feasibility of conducting a PRAMS-like survey with new fathers. The PRAMS for Dads Pilotproject, conducted in Georgia in 2018-2019, used PRAMS mail and phone methodology, with the addition of web methodology, to contact fathers in conjunction with the maternal PRAMS survey, and/or independently of the maternal survey.
- As part of the Zika Postpartum Emergency Response Study, a hospital-based survey was conducted among fathers/partners of women with a recent live birth in Puerto Rico. This study was completed in December of 2017 with a 77% response rate. 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 importance of reaching fathers shortly following the birth of their infant.
Beginning in 2016, 11 PRAMS sites were selected to participate in a collaborative evaluation project with the Human Resources Service Administration (HRSA) to evaluate the impact of the HRSA funded Healthy Start Program. These 11 sites were : 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 livebirth in their state during 2017-2018. All of the Healthy Start participants received the PRAMS survey so that the information they provide can be compared to that of other PRAMS participants who are not Healthy Start participants. In this manner, the impact of the Healthy Start Program on maternal and infant health outcomes that are asked about on PRAMS can be assessed.
In 2011, the PRAMS began working with the W.K. Kellogg Foundation (WKKF) to enhance the existing PRAMS surveillance systems in four states—Louisiana, Michigan, Mississippi, and New Mexico. Within each state, the PRAMS Project expanded the number of women sampled in specific areas (i.e., certain counties and Orleans Parish in Louisiana). Each of the states developed alternative outreach strategies to reach women in these areas. These strategies include distributing and collecting survey questionnaires in person during WIC clinic visits, making prompt calls, and sending text messages to reach women before sending the survey. The data collected by this effort are used to develop sampling and outreach methods to reach women who are traditionally less likely to respond to mail or phone surveys in PRAMS. The data will also assist the W.K. Kellogg Foundation in assessing the effectiveness of their programs to promote maternal and infant health among low-income and minority populations. The project was completed in 2015.