Implementation of the Pregnancy Risk Assessment Monitoring System
(PRAMS) in Richmond, Virginia
Ronna L. Chan
Advisor/Preceptor: Elizabeth Turf, Ph.D.
Objective: To implement the Pregnancy Risk Assessment Monitoring System (PRAMS) in the City of Richmond for a six-week period. The data were used to identify the proportion and characteristics of pregnancies in the City of Richmond that resulted in low birth weight infants, and to examine the characteristics of the women before and during pregnancy. This included characteristics such as pregnancy intent, the utilization of prenatal care, preventive counseling during prenatal care, use of alcohol or tobacco by the mother during pregnancy, incidence of spousal/ partner violence during pregnancy. Finally, the data were used to compare the maternal characteristics and health outcomes of Richmond City mothers with those nationally.
Methods: The Pregnancy Risk Assessment Monitoring System Phase IV Core Questionnaire was used in this study. Confidential data were gathered daily for a specified six-week period in in-hospital interviews from all mothers, who meet the established eligibility requirements, at the Medical College of Virginia Hospital (MCVH) Women’s Specialty Unit in Richmond, Virginia. To meet eligibility requirements, a mother had to meet all of the following criteria: a) between the ages of 18 and 44, b) a residence of Richmond City, c) had a live, singleton birth, d) English speaking. Each participant received a $25 gift certificate to Ukrop’s grocery store upon the completion of the interview. The confidential data collected from MCVH were linked with birth certificate records for analysis. Data was analyzed using SPSS v10.0. to determine the frequencies and characteristics of identified at-risk pregnancies Certain maternal characteristics of Richmond City mothers were compared to the national statistics in the 1998 Pregnancy Risk Monitoring System Surveillance Report. Univariate and multivariate analyses were used to make associations between maternal behaviors, prenatal events, demographics, and poor health outcomes in mothers and infants.
Results: Six of the 12 specific preventive health topics discussed during preventive counseling were reported as discussed in less than 75% of the participants. An extremely low percentage of mothers reported obtaining preventive health counseling on seat belt use (39.3%), partner violence (44.9%), and postpartum depression (47.2%). The prevalence of unintended pregnancy, late entry to prenatal care, Medicaid coverage for prenatal care, WIC participation during pregnancy, alcohol use in the last three months of pregnancy in Richmond City were higher than the highest percentage reported in the national data. The chi-square test showed that gestational age, weight gain during pregnancy, cigarette smoking in the last three months of pregnancy, loss of job during pregnancy, time of entry into prenatal care, preterm/early labor, and severe nausea, vomiting, dehydration were significantly associated with low birth weight. Multivariate regression found severe nausea, vomiting, dehydration, smoking in the last three months of pregnancy, and lost of job were significantly associated with low birth weight.
Conclusion: Maternal characteristics and behaviors that were associated with low birth weight were identified for the City of Richmond. Results from this study showed that the City of Richmond would benefit from education and outreach programs to target at-risk mothers. Health care providers must increase their awareness for the importance of preventive counseling during prenatal care. It is with great hope that Virginia will implement the PRAMS surveillance system state-wide and the data will be compared with the national data.
