PRAMS-Pregnancy Risk Assessment Monitoring System| CDC Reproductive Health

full-text:
PRAMS-Pregnancy Risk Assessment Monitoring System CDC Reproductive Health

What is PRAMS?

PRAMS, the Pregnancy Risk Assessment Monitoring System, 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 before, during, and shortly after pregnancy.

Why does PRAMS exist?

PRAMS was initiated in 1987 because infant mortality rates were no longer declining as rapidly as they had in prior years. In addition, the incidence of low birth weight infants had changed little in the previous 20  years. Research has indicated that maternal behaviors during pregnancy may influence infant birth weight and mortality rates. The goal of the 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 and for describing maternal experiences that may contribute to maternal and infant health.

Why is PRAMS important?

• PRAMS provides data for state health officials to use to improve the health of mothers and infants.
• 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).
• PRAMS enhances information from birth certificates used to plan and review state maternal and infant health programs.
• 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 not only provides state-specific data but also allows comparisons among participating states because the same data collection methods are used in all states.

How are PRAMS data used?

PRAMS provides data not available from other sources about pregnancy and the first few months after birth. These data can be used to identify groups of women and infants at high risk for health problems, to monitor changes in health status, and to measure progress towards goals in improving the health of mothers and infants.
PRAMS data are used by researchers to investigate emerging issues in the field of maternal and child health.
PRAMS data are used by state and local governments to plan and review programs and policies aimed at reducing health problems among mothers and babies.
PRAMS data are used by state agencies to identify other agencies that have important contributions to make in planning maternal and infant health programs and to develop partnerships with those agencies.

Examples of Translation of PRAMS Data

PRAMS Methodology

The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Each participating state samples between 1,300 and 3,400 women per year. Women from some groups are sampled at a higher rate to ensure adequate data are available in smaller but higher risk populations. Selected women are first contacted by mail. If there is no response to repeated mailings, women are contacted and interviewed by telephone. Data collection procedures and instruments are standardized to allow comparisons between states.
For a more detailed description of the PRAMS methodology.
PRAMS Model Protocol 2009 Version* ( ZipFile 623KB) About Zip Files

Is PRAMS data available to outside researchers?

Yes. Researchers may request the PRAMS Analytic Research File for studies that involve multiple states by submitting a proposal to CDC. The submission process is outlined below. Please refer to the Proposal Guidelines and the Application Form (DOC 54KB) for more detailed instructions.

Proposal submissions must include:

1. Application Form. (DOC 73KB)
2. Project Abstract of 350 words or less.
3. Signed Data Sharing Agreement. (PDF 30KB) (including signatures of all authors)

Proposal reviews are conducted once a month. Complete proposals must be received by close of business on the 15th day of the month to be included in the review. Proposals received after the 15th will be reviewed the following month. Submissions should be sent to mailto:PRAMSProposals@cdc.gov?subject=Proposal Review. Incomplete submissions will be returned without review.
Researchers will receive an e-mail regarding the status of their proposal approximately 2 weeks after the review date. Disapproved proposals will be returned with comments. Approved proposals will be forwarded to the PRAMS states for review. Datasets for approved proposals are issued approximately 6–8 weeks following the review date.
NOTE: Requests for PRAMS data for a single state should be directed to that state's PRAMS coordinator. CDC PRAMS does not have authorization from Pennsylvania, Vermont or the South Dakota Tribal Project to release their data using the multi-state proposal process. If you wish to access their data, you will need to contact them directly. Contact information for each state PRAMS coordinator is located on the PRAMS map. Click on the state of interest for contact information.

Other information

Variables in the PRAMS Analytic Research File
The PRAMS Analytic Research File contains a standard set of variables enumerated in the attached file. The PRAMS dataset includes five categories of the following variables:
PRAMS Questionnaire Variable Codebook (DOCX 1MB)

1. Birth Certificate Variables: Selected variables from the birth certificate file are included in the dataset; information on maternal and infant demographics are primarily from this source.
2. Questionnaire Variables: This is the information collected from the PRAMS survey.
3. Analytic Variables: These are precalculated variables that combine different variables in the dataset, often those that are restricted (e.g., body mass index [BMI] created by combining variables on maternal weight and height).
4. Operational Variables: These variables come from the data collection process (e.g., mode the questionnaire was answered in [mail/phone], etc.).
5. Weighting Variables: These variables account for the PRAMS survey design and the statistical weighting of the data. These variables are needed to analyze PRAMS data using complex sample software.*

Because of the PRAMS complex survey design, PRAMS data need to be analyzed using appropriate software that can account for the complex sample. Use of these variables for some software is provided below.

PRAMS Set-up for SUDAAN, SAS Complex Survey, SPSS Complex Samples Modules, and STATA (DOC 40KB)

Researchers can request additional Questionnaire Variables by submitting a list and justifying the need for the variables in their abstract (See Proposal Guidelines, and refer to PRAMS Topic Reference Documents or Standard Question Lists for questions).

NOTE: Requests for additional Birth Certificate Variables are not submitted to CDC. These requests go directly to the PRAMS Coordinators in the states of interest. Researchers are responsible for obtaining individual state approval for any birth certificate variables outside of the PRAMS Analytic Research File. CDC will create datasets for these requests only upon receipt of written permission from each requested state. PRAMS State Coordinator contact information is available at the PRAMS map by clicking on the state of interest.

Questions Available

The PRAMS questionnaire is revised periodically. With each revision (or new phase of the questionnaire), some of the questions change. While most indicators can be compared across phases, it is often easiest to analyze data within a single phase. The years covered by the different phases are listed below:
Phase 6 (2009–2011) No data available yet
Phase 5 (2004–2008) Most recent full year of data available 2007; some 2008 available
Phase 4 (2000–2003)
Phase 3 (1996–1999)
Phase 2 (1990–1995)
Phase 1 (1988–1989) Pilot Phase
The PRAMS questionnaire has three parts; a core that all states use; a bank of standardized optional questions that states may select from; and state-developed questions (usually used only to the state that developed them).
The following documents may be of use:

• Question Lists by Phase (Phase 5 Core List, Phase 5 Standard List, etc.).
• Topic Reference Document by Phase (Lists all questions by topic and indicates which states used standard and state-specific questions on these topics).

Years of Data Available
PRAMS has a minimum overall response rate threshold policy for the release of data. For years 2006 and earlier, this threshold was 70%. Beginning in 2007, the threshold changed to 65%. For any given year, the majority, but not all states meet the threshold. For this reason the number of states with data available may vary from year to year. By requesting “All states/sites with data available” on the application form, CDC will include the appropriate state data in approved datasets.

To see state data availability by year, please refer to the document Data availability by state and year. (DOC 138KB)

Publication of PRAMS analytic results from approved proposals
Researchers should carefully review the terms of the data sharing agreement before submitting abstracts or manuscripts using PRAMS data for publication. In particular, please note:

• Abstracts and manuscripts must be sent to CDC for distribution to PRAMS sites for review at least 2 weeks prior to submission to conferences or journals.
• Publications using PRAMS data should include an acknowledgement of the PRAMS Working Group.(DOC 30KB)

For more information about the request/proposal process, please send an inquiry to PRAMSProposals@cdc.gov.


Data to Action
PRAMS surveillance data can be incorporated into public health decision making, or translated, in a variety of ways. In this booklet, examples show how PRAMS data have been used by states to set priorities, change policies, change programs, and identify new resources.
PRAMS and Breastfeeding (PDF 556KB)
Breastfeeding is generally recognized as the optimum form of nutrition for infants. Many professional health organizations have adopted policies in support of breastfeeding.
PRAMS and Postpartum Depression
Depression among mothers in the months after delivery has surfaced as an important maternal and child health concern ...more
PRAMS and Unintended Pregnancy
According to the 1995 National Survey of Family Growth (NSFG), 49% of pregnancies in the United States (excluding miscarriages) and 31% of pregnancies resulting in a live birth are unintended ...more
List of Publications Using Multistate PRAMS Data* (DOC 61KB)
Other PRAMS fact sheets.
Go to What States Participate in PRAMS to see lists of state publications using PRAMS data