Georgia Pregnancy Risk Assessment Monitoring System (PRAMS)

The Georgia Pregnancy Risk Assessment Monitoring System (PRAMS) is a Centers for Disease Control and Prevention (CDC)-funded research project conducted by the Georgia Department of Public Health (DPH) designed to collect information on mothers and babies. Georgia PRAMS began in January 1993 and supplements birth certificate data by providing information on women's attitudes, experiences, and behaviors before, during, and after the delivery of their live born infant.

About Georgia PRAMS

PRAMS is an ongoing, site-specific, population-based surveillance system designed 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. The goal of Georgia PRAMS is to improve the health of mothers and babies in Georgia by reducing the risk of adverse birth outcomes such as low birth weight, preterm birth, and infant and maternal morbidity and mortality.

Georgia PRAMS aids in the planning and evaluation of programs and policies aimed toward reducing health problems among mothers and babies in Georgia. Additionally, Georgia PRAMS data are used by researchers to investigate emerging issues in the field of maternal and child health.

Georgia PRAMS Methodology

Each month, a stratified random sample of approximately 100-150 mothers is chosen to participate from the Georgia birth certificate registry. Mothers are mailed a Georgia PRAMS questionnaire two to six months post-delivery that consists of about 80 questions, along with an introductory letter, a consent card, and a resource brochure that includes telephone numbers for various Georgia programs. PRAMS is a mixed-mode (mail and telephone) surveillance system that focuses on repeated, but varied contact attempts through the use of personalized mailings and phone calls. The primary data collection mode is mail, with telephone follow-up for all mail nonrespondents. 

The Georgia PRAMS questionnaire consists of two parts. First, there are core questions that are asked by all participating PRAMS states, including questions about the following:

  • Attitudes and feelings about the most recent pregnancy
  • Preconception care
  • Content of prenatal care
  • Medicaid and WIC participation
  • Breastfeeding
  • Cigarette smoking and alcohol use
  • Health insurance coverage
  • Physical abuse
  • Infant health care
  • Contraceptive use

The remaining questions on the survey are chosen from a pretested list of standard questions developed by CDC. Georgia PRAMS includes expanded questions on prenatal care visits, breastfeeding, vaccination during pregnancy, postpartum depression, home visiting program visits during and after pregnancy, and infant safe sleep. Supplements may be developed to append to the end of the regular PRAMS survey and are used for a short period for data collection on topics of emerging concern. 

PRAMS sites often oversample subpopulations, also known as stratifying, to draw stronger conclusions about various factors of interest. Statistical weighting schemes account for the different sampling rates in different strata, allowing estimates from these groups to be combined to obtain state-level estimates that ultimately reflect the actual proportions of births attributed to these subpopulations.

  • Georgia PRAMS Stratification by Year
     

    Year  

    Strata

    2004

    Low Birthweight; Normal Birthweight; Black; Non-Black

    2005

    Low Birthweight; Normal Birthweight; Black; Non-Black

    2006

    Low Birthweight; Normal Birthweight; Black; Non-Black

    2007

    Low Birthweight*, Clayton County; Low Birthweight*, all other Georgia counties; Normal Birthweight

    2008

    Low Birthweight*, Chatham County; Low Birthweight*, all other Georgia counties; Normal Birthweight

    2009

    Low Birthweight*, Lowndes County; Low Birthweight*, all other Georgia counties; Normal Birthweight

    2010

    All Birthweight, Burke & McDuffie Counties; Low Birthweight*, all other Georgia counties; Normal Birthweight, all other Georgia counties

    2011

    All Maternal Ages, All Birthweight, Burke & McDuffie Counties; Teen Mothers+, All Birthweight, all other Georgia counties; Adult Mothers, Low Birthweight*, all other Georgia counties; Adult Mothers, Normal Birthweight, all other Georgia counties

    2012

    Teen Mothers+; Adult Mothers; Low Birthweight*; Normal Birthweight

    2013 - 2015

    Counties identified as infant mortality clusters in 2012 (Bibb, Chatham, Fulton, Lowndes, Muscogee, Richmond); All other Georgia counties

    2016 - 2017

    Pre-pregnancy Chronic Conditions (e.g., diabetes and hypertension)

    2018

    Premature infant (between 20-36 weeks gestation), Healthy Start Augusta Participants

    2019

    Premature infant (between 20-36 weeks gestation)

    2020

    Premature infant (between 20-36 weeks gestation)

    2021

    Premature infant (between 20-36 weeks gestation)

    2022

    Premature infant (between 20-36 weeks gestation)
    2023 Premature infant (between 20-36 weeks' gestation)
    Note:*"Low Birthweight" refers to infants who weighed less than 2,500 grams at birth, while "Normal Birthweight" refers to infants who weighed 2,500 grams or more at birth; "Teen Mothers" refers to mothers who were 19 years old or younger at the time of their new baby was born, while "Adult Mothers" refers to mothers who were 20 years old or older at the time their new baby was born.

     

The PRAMS questionnaire is revised periodically. With each revision or phase of the questionnaire, some of the questions change. Although most indicators can be compared across phases, it is often easiest to analyze data within a single phase. Currently, the PRAMS questionnaire is in phase 9. 

Georgia PRAMS Questionnaires

Phases + Supplements 

Because PRAMS employs a mixed-mode methodology, three modes of response are currently available for survey participation and include mail, phone, and web. The self-administered questionnaire is used with the mail mode through mailing packets, along with web mode which is accessible through a website link or QR code. Additionally, the interviewer-administered questionnaire is used during the telephone mode if a participant does not complete the survey by mail or web. The interviewer-administered questionnaire contains the same questions that are on the self-administered questionnaire; however, some questions have been formatted differently to facilitate the different mode of administration.

The PRAMS questionnaire is available in English and in Spanish.

Georgia PRAMS Data Requests

Researchers may request data for various Phase 8 cohorts by submitting a proposal to the online DPH Data Request portal. The submission process is outlined below.

  • Data Submission Steps & Codebooks

    1. Go to the PRAMS Data Request to the JustFOIA site: https://gadph.justfoia.com/publicportal/home/newrequest

    2. Accompanying documents that must be uploaded include: 

     
    *Data unavailable for 2015 & 2016

     

    Variables in the PRAMS Analytic Research File

    The PRAMS Analytic Research File contains a standard set of variables. There are five categories of the variables provided:

    1. Birth Certificate Variables: Selected variables from the birth certificate file are included in the data set; information on maternal and infant demographics are primarily from this source.
    2. Operational Variables: These variables come from the data collection process (e.g., mode the questionnaire was answered by mail or phone).
    3. 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.
    4. Questionnaire Variables: This is the information collected from the PRAMS survey.
    5. Analytic Variables: These are precalculated variables that combine different variables in the data set, often those that are restricted (e.g., body mass index [BMI] created by combining variables on maternal weight and height).

     

  • Health Indicators & Helpful Tips

    Below is listed some standard demographic and maternal and infant health indicators we commonly use to understand key disparities in outcomes of interest:

    Demographics

    • Maternal Age (years) < 25, 25-34, 35+
    • Maternal race/ethnicity – Non-Hispanic Black; non-Hispanic White; non-Hispanic Other, and Hispanic
    • Maternal education level – Less than high school; high school graduate or GED; some college, no degree; college graduate or higher
    • Payor for Delivery – private insurance; Medicaid; or other (including self-pay, /TRICARE, other government insurance, and "other" categories)
    • Federal Poverty Level – Recommend either three categories (<=100%, 101-200%, and >200%) or two categories (<= 200%, > 200%)
    • Urban/Rural – 2 categories, classified by maternal county of residence using one the following classification scheme:
      • Metropolitan (classified as urban)
        • Large  (1 million+)
        • Medium (250,000-999,999)
        • Small  (less than 250,000) 
      • Nonmetropolitan (classified as rural)
        • Micropolitan (10,000-49,999)
        • Noncore (Nonmetropolitan counties that did not qualify as micropolitan)

    Maternal and Infant Characteristics:

    • Pregnancy intention – intended; mistimed; unwanted; and uncertain
    • Previous live birth – none; one or more
    • Birthweight – Very/low birth weight (<2,500 g); normal birth weight (>=2,500 g)
    • Adequacy of prenatal care  - Inadequate; at least adequate (per Kotelchuck index)
    • Gestational age – premature (<37 weeks); not premature (>= 37 weeks)

     

    We do not release PHI such as birth certificate numbers, DOBs, counties, due to confidentiality of our participants. Further, we suppress any estimates with a numerator < 5 or denominator < 30 and flag estimates with a denominator between 30-59 to be interpreted with caution.

     

      Analysis Tips

     

    For assistance requesting Georgia PRAMS data, please contact the Georgia PRAMS Team at [email protected].

Georgia PRAMS Publications

Tobacco Use During Pregnancy Infographic

Secondhand Smoke Exposure During Pregnancy Infographic

Georgia PRAMS WIC Breastfeeding Data Summary

Georgia PRAMS Special Projects

PRAMS for Dads Pilot Project

Fathers play key roles in the health and development of their families. Georgia PRAMS has partnered with researchers at Northwestern University to conduct a PRAMS-like survey for recent fathers. The purpose of PRAMS for Dads is to better understand the role of fathers in the health of families in Georgia. 

 

Contact Information

Georgia PRAMS Project

Division of Epidemiology, Maternal and Child Health Section

200 Piedmont Ave. SE, Atlanta GA 30334

PHONE  470-716-2069 

[email protected]

Page last updated 7/12/23