Pregnancy Risk Assessment Monitoring System (PRAMS)
PRAMS is an ongoing project of the Centers for Disease Control and Prevention (CDC) with state health departments. PRAMS collects information from women who have recently delivered a baby to find out their attitudes and experiences immediately before, during and following their pregnancy. The Maryland Department of Health (MDH) started collecting PRAMS data in 2000.
The questionnaire consists of two parts. First, there are core questions that appear on all states' surveys. The core questionnaire includes barriers to and content of prenatal care, obstetric history, maternal use of alcohol and cigarettes, physical abuse, contraception, economic status, maternal stress, and early infant development and health status. Second, there are state-added questions that are tailored to each state's needs. Maryland topics include assisted reproduction (fertility drugs), automobile safety, depression and anxiety, oral health, flu vaccination, social services, and contraceptive care.
Women eligible to participate in PRAMS are selected from Maryland's live birth certificate files. Each month, a stratified, random sample of approximately 200 live births is selected. The sample is stratified by infant birth weight (=2500 grams). This sampling frame over-samples mothers who have delivered a low birth weight infant (= 35 years). For year 2001 births, the sample stratified maternal age by =35 years.
PRAMS combines two modes of data collection including a survey conducted by mailed questionnaire with multiple follow-up attempts, and if mail is not successful, a survey conducted by telephone interview. Survey questionnaires and other materials are available in both English and Spanish.
The first mailing, which is done two to four months after delivery, is a letter that introduces PRAMS to the mother and informs her that a questionnaire will soon arrive. Within seven days of this letter, the questionnaire packet is mailed. This packet includes the 73-item survey, informed consent page, calendar, and resource brochure. In addition, a manicure file is sent to all mothers as an incentive for completing the survey. Those mothers who complete and return their survey are entered into a drawing for a chance to win a $100 Target gift card reward. Seven to 10 days after the initial packet is mailed, a Tickler that serves as a thank you and reminder note is sent. Mothers who do not respond to the Tickler within seven to 14 days are mailed a second questionnaire packet. A third questionnaire packet is mailed to all remaining nonrespondents seven to 14 days later. Telephone follow-up is initiated for all nonrespondents.
Data collected through PRAMS are linked to birth certificate data, which allows for the survey data to be weighted to reflect the total birth population. Sampling, nonresponse and noncoverage adjustment factors are applied to the data in order to make the results generalizable to the state's population of women delivering live born infants during the study period. Further information on PRAMS methodology, including weighting procedures, may be found on the CDC website.