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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
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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
Note:*"Low Birthweight" refers to infants who weighted less than 2,500 grams at birth, while "Normal Birthweight" refers to infants who weighted 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.
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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 8.
Georgia PRAMS Questionnaires
Phase 8 + Supplements
Georgia PRAMS Questionnaires
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2022 Questionnaire (Current)
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2021 Questionnaire
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2020 Questionnaire
P8
+ Disability + Oral Health + Emergency Prep+ Mental Health- English
P8
+ Disability
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Oral Health + Emergency Prep + Mental Health- Spanish
*CDC COVID-19 Experience Supplement collected batches 321-323
**State COVID-19 Supplement collected batches 313-320
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2019 Questionnaire
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2016-2018 Questionnaires
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Phase 8: Core Questions + Standard Questions + Topic Map
PRAMS topic maps provide a brief description of topics and subjects included in each phase questionnaire and the questions associated with each topic.
Because PRAMS employs a mixed-mode methodology, two types of questionnaires are currently available. The self-administered questionnaire is used with the mailing packets, and an interviewer-administered questionnaire is used with the telephone phase. 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.
Georgia PRAMS Data Requests
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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:
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Data
Request Form*
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Data
Sharing Agreement Form
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Data-to-Action
Success Story (Template)
- Please submit at the completion of your research project
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Data-to-Action
Success Story (Example)
*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:
- 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.
- Operational Variables: These variables come from the data collection process (e.g., mode the questionnaire was answered by mail or phone).
- 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.
- Questionnaire Variables: This is the information collected from the PRAMS survey.
- 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).
Georgia PRAMS Codebooks
Phase
8 Questionnaire Codebook
Phase
8 Analytical/ Birth Certificate/ Operational/ Weighting Codebook
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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)
- Metropolitan (classified as urban)
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.
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
2 Peachtree Street, NW / 14th Floor / Atlanta, GA 30303-3142
PHONE 470-716-2069
Page last updated 2/28/23