Pregnancy Risk Assessment Monitoring System (PRAMS)

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a joint surveillance project of the Centers for Disease Control and Prevention, Division of Reproductive Health (CDC, DRH) and state health departments. Developed in 1987, PRAMS collects state-specific, population-based data on maternal behaviors and experiences before, during, and shortly after pregnancy. Its purpose is to reduce infant morbidity and mortality by influencing programs and policies aimed at reducing health problems among mothers and infants. PRAMS is an ongoing 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.

PRAMS data include basic demographic information, barriers to and content of prenatal care, health insurance coverage, maternal use of cigarettes and e-cigarettes, postpartum depressive symptoms, contraceptive use, and early infant development and health status.

The PRAMS sample of women who have had a recent live birth is drawn from the state's birth certificate file. Each participating state draws a stratified systematic sample of 100 to 250 new mothers every month from a frame of eligible birth certificates. Many states oversample low weight births or stratify by mother's race or ethnicity. Annual sample sizes range from 1,000 to 3,400, divided among three to six strata. Typically, the annual sample is large enough for estimating statewide risk factor proportions within 3.5 percent at 95 percent confidence. Mothers' responses are linked to extracted birth certificate data items for analysis. Thus, the PRAMS data set also contains a wealth of demographic and medical information collected through the state's vital records system. The sampling procedures allow for results that are generalizable to the state's entire population of annual live births. Nonresponse adjustment factors attempt to compensate for the tendency of women having certain characteristics (such as being unmarried or of lower education) to respond at lower rates than women without those characteristics.

In 2017, annual sample size among PRAMS sites ranged from 1,020 – 3,566; weighted response rates ranged from 33% - 70%.

As of 2020, all states except California, Idaho, and Ohio participate in PRAMS, representing approximately 83% of U.S. births. PRAMS data are combined with the similar California Maternal and Infant Health Assessment (MIHA) data Healthy People measures to provide near-national estimates representing 96% of U.S. births. The projects collaborate to ensure that identical questions are included on topics reported for Healthy People.