Louisiana Pregnancy Risk Assessment Monitoring System (Louisiana PRAMS)
Louisiana PRAMS is an ongoing, population-based risk factor surveillance system designed to describe selected maternal behaviors and experiences that occur before and during pregnancy as well as during a child's early infancy.
Lousiana PRAMS data provide information on:
- Prenatal maternal behaviors and experiences: pregnancy intention, contraceptive use, alcohol use, tobacco use, physical abuse, life stress, counseling
- Complications of pregnancy: hypertension, diabetes, hospitalization
- Postpartum maternal behaviors and experiences: depression, breastfeeding, contraceptive use, safety, infant sleep position
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 not changed much in the previous 20 years. Louisiana PRAMS data collection began October of 1997. No data are available for 2005 and limited, partial year data are available for 2006 due to disruptions in operational activities resulting from Hurricane Katrina. Louisiana's infant mortality rate has long been one of the highest in the country. More babies die before reaching age one here than in most other states. Research has indicated that maternal behaviors during pregnancy may influence infant birth weight and mortality rates. Louisiana PRAMS hopes to improve the health of mothers and infants by identifying factors associated with adverse outcomes and making recommendations for new programs to reduce these 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.
Mission and Vision
The goal of Louisiana PRAMS is to reduce infant morbidity and mortality by impacting maternal and child health programs, policies, and maternal behaviors during pregnancy and early infancy. Findings from Louisiana PRAMS are meant to be used to enhance the understanding of maternal behaviors and their relationship with adverse pregnancy outcomes and aid in the development and assessment of programs designed to identify high-risk pregnancies and reduce adverse pregnancy outcomes.
The PRAMS questionnaire is mailed to approximately 200 Louisiana women each month (approximately 3.0% of live births in the state). Mothers who are asked to complete the questionnaire are randomly selected from the list of birth certificates in Louisiana's Vital Record Registry. Once participants complete and return the surveys to the Office of Public Health, answers are grouped to provide representative data for the entire state. If no response is received after three survey mailings, mothers are then contacted and interviewed by telephone. Participation in the Louisiana PRAMS study is entirely voluntary and every woman selected to complete the survey has the right to refuse without loss of any services.
The core set of questions and the questions developed specifically for Louisiana collect information on many topics, including:
- Attitudes and feelings about pregnancy
- Prenatal care and barriers to care
- Maternal socio-economic situation
- Physical abuse before and during pregnancy
- Psychosocial support and stress
- Maternal alcohol and tobacco use
- Information provided by healthcare providers on pregnancy-related health issues, such as breastfeeding; dental care; adverse effects of tobacco and alcohol; benefits of folic acid; risks of HIV; and contraception options available after pregnancy.
- Complications during pregnancy
- Infant health care
- Home safety and injury prevention
- Health care coverage during pregnancy and delivery
PRAMS data can be used for many purposes and can be disseminated in many ways. The following list outlines examples of the ways PRAMS data can be used and disseminated:
- Assessing existing public health programs.
- Developing and implementing new programs.
- Modifying existing programs.
- Monitoring progress toward Healthy People 2010 and Healthy People 2020 objectives or other state health goals.
- Supporting legislative proposals.
- Providing data for Title V Block Grant needs assessments.
- Informing communities about statewide prevalence of prenatal behaviors.
- Determining patterns of using public health programs.
PRAMS data were used to identify weight gain as one of the most important risk factors for low birth weight. Based on PRAMS data, the Louisiana Office of Public Health launched a media campaign addressing healthy weight gain during pregnancy. The campaign was administered by the Partners for Healthy Babies project, the Maternal and Child Health Program and the by the Nutrition Program. The campaign consists of a television and a radio spot, which began broadcast in September 2003 and ran through December 2003. In addition, the MCH State Epidemiologist and Nutritionist provided a presentation on adequate prenatal weight gain and the importance of their role in promoting adequate prenatal weight gain to approximately 100 nurses at the Louisiana Association of Women's Health, Obstetric, and Neonatal Nurses in October 2003.
PRAMS data presentations have been made to The Louisiana Perinatal Commission, the Louisiana Maternal and Child Health Coalition, Healthy Start of Greater New Orleans, LSU Medical Center Grand Rounds and Tulane University School of Public Health and Tropical Medicine.
PRAMS data are a source of information for the required annual MCH Block Grant reporting on the following: the National Performance Measure on the percentage of mothers who report smoking during the last three months of pregnancy and the State Negotiated Performance Measures on the percent of women who use alcohol during the last three months of pregnancy, percent of unintended pregnancies among women who had a live birth, percent of infant back sleep position among African American women, and the percent of women having a live birth who reported being told prior to pregnancy that they had Type 1 or Type 2 diabetes.
Louisiana PRAMS data request application to request case level and aggregate data.
Louisiana PRAMS Surveillance Reports:
For additional information or questions, please contact:
Jane Herwehe, MPH
Lead, Data Action Team