Problem/condition: In 2006, CDC published recommendations to improve health and health care for women before pregnancy and between pregnancies (CDC. Recommendations to improve preconception health and health care--United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006;55[No. RR-6]). The Pregnancy Risk Assessment Monitoring System (PRAMS) provides data concerning maternal behaviors, health conditions, and experiences for women in the United States who have delivered a live birth.
Reporting period covered: 2004.
Description of system: PRAMS is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants in selected states and cities in the United States. PRAMS employs a mixed mode data-collection methodology; up to three self-administered questionnaires are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data from 26 PRAMS reporting areas that collected data during 2004 and that had achieved overall weighted response rates of > or =70% and had weighted data available by the time the analysis was conducted in January 2007. Data are reported on indicators regarding 18 behaviors and conditions that are relevant to preconception (i.e., prepregnancy) health and health care and 10 that are relevant to interconception (i.e., postpartum) health and health care. The number of questions that were administered varied by site; certain questions were not asked for all reporting areas.
Results: With respect to preconception maternal behaviors and experiences, mean overall prevalence was 23.2% for tobacco use, 50.1% for alcohol use, 35.1% for multivitamin use at least four times a week, 53.1% for nonuse of contraception among women who were not trying to become pregnant, 77.8% for ever having a dental visit before pregnancy, 30.3% for receiving prepregnancy health counseling, 3.6% for experiencing physical abuse, and 18.5% for experiencing at least four stressors before pregnancy. With respect to preconception maternal health conditions, mean overall prevalence was 13.2% for women being underweight (body mass index [BMI]: <19.8), 13.1% for being overweight (BMI: 26.0-29.0), and 21.9% for being obese (BMI: > or =29.0). Mean overall prevalence was 1.8% for having diabetes, 6.9% for asthma, 2.2% for hypertension, 1.2% for heart problems, and 10.2% for anemia. Among women with a previous live birth, the mean overall prevalence of having a previous low birth weight infant was 11.6% and of having a previous preterm infant was 11.9%. With respect to interconception maternal behaviors and experiences, mean overall prevalence was 17.9% for tobacco use, 85.1% for contraceptive use, 15.7% for having symptoms of depression, and 84.8% for having social support. Mean overall prevalence was 7.5% for the most recent infant being born low birth weight, 10.4% for having a recent preterm infant, 89.3% for having a check-up, 89.0% for receiving contraceptive use counseling, 30.4% for having a dental visit, and 48.6% for receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Results varied by maternal age, race/ethnicity, pregnancy intention, and health insurance status. For certain risk behaviors and health conditions, mean overall prevalence was higher among women aged <20 years, black women, women whose pregnancies were unintended, and women receiving Medicaid; however, no single subgroup was consistently at highest risk for all the indicators examined in this report.
Interpretation: PRAMS results varied among reporting areas. The prevalence estimates in the majority of reporting areas and for the majority of indicators suggest that a substantial number of women would benefit from preconception interventions to ensure that they enter pregnancy in optimal health. The results also demonstrate disparities among age and racial/ethnic subpopulations, especially with respect to prepregnancy medical conditions and access to health care both before conception and postpartum. Differences also exist in health behaviors between women who reported intended and unintended pregnancies.
Public health action: Maternal and child health programs can use PRAMS data to monitor improvements in maternal preconception and interconception behaviors and health status. The data presented in this report, which were collected before publication of CDC's recommendations to improve preconception health and health care in the United States, can be used as a baseline to monitor progress toward improvements in preconception and interconception health following publication of the recommendations. These data also can be used to identify specific groups at high risk that would benefit from targeted interventions and to plan and evaluate programs aimed at promoting positive maternal and infant health behaviors, experiences, and reproductive outcomes. In addition, the data can be used to inform policy decisions that affect the health of women and infants.