Pregnancy Risk Assessment Monitoring System

	See Also: • PRAMS Web Site

CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state-specific, population-based surveillance system designed to identify and monitor selected maternal behaviors and experiences that occur before, during, or after pregnancy among a sample of women who have recently given birth to a live infant. 

The purpose of PRAMS is to improve the health of mothers and infants by reducing adverse outcomes such as low birth weight, infant mortality, and maternal illnesses.

Facts About Infant Mortality

• In 1999, the leading causes of infant mortality were congenital anomalies, disorders related to immaturity (short gestation and unspecified low birth weight), sudden infant death syndrome (SIDS), and maternal complications that affect the newborn.
• The nation’s infant mortality rate fell from 20 deaths per 1,000 live births in 1970 to 7.1 deaths per 1,000 live birth in 1999.
• In 1999, the maternal mortality rate was 9.9 deaths per 100,000 live births.
• Disparities in the early use of prenatal care continue. In 1998, 84.8% of white women began care in the first trimester compared with 73.3% of black women and 75.3% of Hispanic women. 

Costs

Infants born too small use more resources than normal weight infants. They often need time in neonatal intensive care unit at a cost ranging from $1,000 to $2,500 per day. The lifetime costs for one premature baby are conservatively estimated at $500,000. Low birth weight accounts for 10% of all health care costs for children. 

PRAMS Goals

The goal of PRAMS is to reduce infant illness and death by improving maternal behaviors during and immediately after pregnancy. To achieve that goal, PRAMS has four objectives:

• To collect population-based data of high scientific quality on topics related to pregnancy and early infancy.
• To conduct comprehensive analyses to understand better the relationships between behaviors, attitudes, and experiences during and immediately after pregnancy.
• To translate results of analyses into information useful for planning and evaluating pregnancy-related public health programs and policies.
• To build the capacity of states to collect, analyze, and translate data to address relevant public health issues. 

Effectiveness of PRAMS Data

	In 1997, four states included oral health questions on their PRAMS survey. PRAMS data from three states showed about half of women having dental problems during pregnancy actually received dental care. More states have added oral health questions to their PRAMS survey.

PRAMS data are continually being analyzed, disseminated, and translated into vital information for public health action. For example

• Florida’s PRAMS data were used in support of the state’s lawsuit against tobacco companies: the PRAMS data showed the level of smoking by pregnant women, especially by pregnant women who receive Medicaid.
• Alaska’s PRAMS data on unintended pregnancy were used as a part of the prevention initiative of the Alaska Department of Health and Social Services. The initiative allowed state and federal funds to be used to set up family planning services in new locations and for specific groups of people (e.g., teenagers, low-income women).

Examples of CDC Activities

CDC provides funds to 32 states and New York City to implement PRAMS in their areas. In addition, CDC is involved in the following activities:

• Research on the disparity in infant mortality rates between blacks and whites.
• Community research projects to reduce infant mortality under CDC’s REACH (Racial and Ethnic Approaches to Community Health) 2010 projects.
• Research on sudden infant death syndrome (SIDS).
• State and local maternal and child health programs to reduce infant mortality 

Examples of State Activities

In 2001, CDC expanded PRAMS to include three new projects in Montana, North Dakota, and Colorado. The new Montana and North Dakota projects use point-in-time methods to collect data from women who recently gave birth. The Colorado Project has added a multipronged component to its standard PRAMS project: 

• Local PRAMS sampling in counties or regions covered by three local health departments in Colorado.
• An intensive effort to find African American women who recently gave birth and to oversample this group of women.
• Linking of birth certificate data and PRAMS data with Colorado’s Medicaid database.
• Adding PRAMS data to the data in CoHID, a database of Colorado health information available on the Internet.

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This page last reviewed August 10, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion