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Technical Notes 2018

Pregnancy Risk Assessment Monitoring System (PRAMS)

2018 PRAMS Topics for North Carolina

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS collects state-specific, population-based data on maternal attitudes, behaviors and experiences before, during and immediately after pregnancy. PRAMS data collection began in North Carolina in 1997.

A PRAMS questionnaire is mailed to approximately 150 randomly selected new mothers each month. Sampled mothers receive up to three mailed surveys, followed by telephone contact for women who did not respond to the mailings. More detailed information on PRAMS survey methodology can be found on the CDC PRAMS website.  The North Carolina PRAMS questionnaire is available in English and Spanish.
The PRAMS questionnaire includes questions that are asked by all state PRAMS programs as well as state-specific questions. The questionnaire addresses maternal and child health issues such as unintended pregnancy, breastfeeding, smoking and alcohol use, insurance coverage, contraception use, post-partum depression and intimate partner violence.  

The CDC periodically revises the questions and layout of the survey. Beginning with January 2017 births, N.C. PRAMS began implementing the Phase 8 revision to the PRAMS questionnaire. The latest revision included the addition of several new questions, deletion of some questions and wording changes to some existing questions. Those changes are summarized in the tables at the end of this document. For a link to all phases of the PRAMS questionnaires, please visit our PRAMS – Annual Questionnaires page.

Interpreting Annual Results Tables

Detailed data tables for N.C. PRAMS survey items are posted on an annual basis. Exact wording for each question is used as a title for most survey items; however, due to space limitations, titles may not include some introductory remarks and explanations for some questions. For further information on survey questions, refer to the corresponding annual questionnaire available at the Questionnaires section of this site.

State level estimates are available for survey items tabulated by characteristics of the mother, including age, race/ethnicity, education, marital status, WIC recipient status, Medicaid enrollment status, and infant’s birth weight level. County-level estimates are not reported due to the small sample size of the PRAMS survey.

Percentages shown in N.C. PRAMS data tables are calculated using weighted data and therefore cannot be derived exactly from the numbers in the tables. The data are weighted annually by Centers for Disease Control and Prevention (CDC) to adjust for nonresponsive, non-coverage, and sampling fractions.  The weighting procedure adjusts the results of the sample to better represent the entire population of new mothers in North Carolina.  

N.C. PRAMS data tables present the 95 percent confidence interval (C.I.) associated with each estimate, or percent, reported in the tables. Given the complex sample design of the N.C. PRAMS Survey, the State Center for Health Statistics uses SAS-callable SUDAAN software to calculate the point estimates and confidence intervals. This software takes into account the complex sampling design when computing the variance, or sampling error, associated with the estimates. The 95 percent confidence interval indicates the range in which the true population value would occur 95 out of 100 times, if 100 different random samples were taken of the population.

When interpreting results, the reader should consider both the sample size and the width of the confidence intervals. One should use caution in interpreting cell sizes less than 50. “Cell size” refers to either the number of respondents found in the denominator (i.e., the table column labeled, "Total Respond") or the numerator (defined by the number of respondents associated with the response categories, e.g., "Yes-No").  It is the practice N.C. PRAMS suppresses results based on these criteria, the reader should take note when this occurs and should view the corresponding results as unreliable.

For example, refer to the 2015 PRAMS web table on Sleep Position and Bed Sharing. For the question, "How do you most often lay your baby down to sleep now?" a total of 43 respondents under age 20 answered the question and 21 of these respondents reported "Recommended (Back)" Here, the number in the denominator is 43 and the number in the numerator is 21, yielding a weighted percentage of 50.6%; however, the associated confidence interval ranges from 32.4% to 68.6%. The half-width for this confidence interval is 18.1 percent. Clearly, these results have a large degree of statistical error. In this case, the results for respondents under age 20 should be viewed cautiously and considered unreliable.    

Respondents who refused to answer or did not know the answer to a survey question were excluded from calculations in the data tables. However, for a few questions "Don't know/Not sure" responses provide valuable information and were included in the calculations. The denominator for each calculation is the number of participants who responded to the item. Exceptions are specified in the footnote of the corresponding data table.

More info on PRAMS methodology and data collection may be found in our Pregnancy Risk Assessment Monitoring System (PRAMS) section.

Summary of Changes from Phase 7 (2012-15) to Phase 8 (2016 forward) PRAMS Questionnaire


Phase 7 (2012-2015) Questions that were Dropped from the
Phase 8 (2016 forward) PRAMS Survey
Phase 7
Question #
Brief Description of Dropped Question
7e 12 months prior to pregnancy - e. I visited a health care worker and was checked for high blood pressure
7f 12 months prior to pregnancy - f. I visited a health care worker and was checked for depression or anxiety
11c Medical Provider discussions prior to pregnancy - c. Getting my vaccines updated before pregnancy
11d Medical Provider discussions prior to pregnancy - d. Visiting a dentist before pregnancy
11e Medical Provider discussions prior to pregnancy - e. Getting counseling for any genetic diseases that run in my family
11g Medical Provider discussions prior to pregnancy – g. Getting counseling or treatment for depression or anxiety
11h Medical Provider discussions prior to pregnancy - h. The safety of using prescription or over-the-counter medicines during pregnancy
11j Medical Provider discussions prior to pregnancy - j. How drinking alcohol during pregnancy can affect a baby
11k Medical Provider discussions prior to pregnancy - k. How using illegal drugs during pregnancy can affect a baby
14 How much longer wanted to wait to become pregnant
23e Medical Provider discussions during prenatal visits - e. Using a seat belt during my pregnancy
23f Medical Provider discussions during prenatal visits - f. Medicines that are safe to take during pregnancy
23h Medical Provider discussions during prenatal visits - h. Doing tests to screen for birth defects or diseases that run in my family
23i Medical Provider discussions during prenatal visits - i. The signs and symptoms of preterm labor (labor more than 3 weeks before the baby is due)
24 Test for HIV during pregnancy
27 Date when flu shot received
29 Childbirth class to learn what to expect during labor and delivery
30 Home visitor during pregnancy
31 Number of visits by a home visitor during pregnancy
32 Types of things discussed with a home visitor during pregnancy
33 WIC during pregnancy
47 Weight gain during pregnancy
48 Baby intensive care unit stay
56.5 Reason stopped breastfeeding – Option #5 - Because it was too hard, painful, or too time consuming
58 First time baby drank liquids other than breast milk
59 First time baby ate food such as baby cereal, baby food or other food
61 How often baby slept in same bed with mom or anyone else
62 Home visitor after delivery
64.8 Reasons for not using birth control now – Option #8 - Partner had a vasectomy
70 Rules about smoking inside home during pregnancy
72c Types of help available during pregnancy - c. Someone to take me to the clinic or doctor’s office if I needed a ride
73b Prenatal visit discussion -  b. The bacteria B Strep
73c Prenatal visit discussion -  c. Placing your baby to sleep on his or her back or side
73d Prenatal visit discussion -  d. If someone was hurting you emotionally
74 Multivitamin use after pregnancy
75 Tdap vaccination before, during, after pregnancy

New Questions in Phase 8 of the PRAMS Survey (2016 forward)
Phase 8
Question #
Brief Description of New Question
10 Health care visits 12 months prior to pregnancy
11 Type(s) of health care visit had 12 months before got pregnant
12 Reworded preconception questions having more answer options (12d, 12e, 12g, 12i, 12j, 12k, 12l)
13.2 Health Insurance 12 Months Prior to Pregnancy – Option #2 - Private health insurance from my parents
14.1 Health Insurance During Pregnancy/Prenatal Care – Option #1 - I did not go for prenatal care
14.3 Health Insurance During Pregnancy/Prenatal Care – Option #2 - Private health insurance from my parents
15.2 Health Insurance After Delivery  – Option #2 Private health insurance from my parents
21 Weeks/months when mom was sure about pregnancy
25b Prenatal visit discussion -  b. If I was taking any prescription medication                                                   
25j Prenatal visit discussion -  j.  If I planned to use birth control after my baby was born             
30 Types of things made it hard for mom to go to a dentist during pregnancy
31 b & c Health conditions during pregnancy (b. High blood pressure, c. Depression)
37a & b Other products used in the past 2 years (a. E-cigarettes b. hookah)
38 E-cigarette use before pregnancy
39 E-cigarette use during pregnancy
45b Physical abuse occurring during pregnancy – b. My ex-husband or ex-partner
51 Before or after pregnancy information received about breastfeeding
54 Breastfeeding help after baby was born
57.11 Reasons for stopping breastfeeding – Option #11 - My partner did not support breastfeeding
58f Hospital experiences after delivery – f. My baby was placed in skin-to-skin contact within the first hour of life
60 In the past 2 weeks, frequency of baby sleeping alone in his/her crib or bed
61 Whether baby’s crib or bed placed in mother’s room
62 The way baby slept in the past 2 weeks
63 Types of things any health care worker told mom about placing baby
68 Types of things discussed during postpartum checkup
72 Work leave question: If mom worked at a job for pay during pregnancy
73 Work leave question: If returned to work after pregnancy
74 Work leave question: If mom took leave after delivery
75 Work leave question: Length of time mom took from work
76 Work leave question: Types of things affected mom’s decision about taking leave
77 Work leave question: If baby’s father took leave from work after baby was born
78d Social support after delivery - d. Someone to take care of my baby
78e Social support after delivery - e. Someone to help me if I were tired and feeling frustrated with my new baby

Phase 7 (2012-15) PRAMS Survey Questions that were
Modified in Phase 8 (2016 forward)
Phase 8
Question #
Phase 7
Question #
Brief Description of Change(s)
7b 7b Fewer answer options; wording changes
7d 7d Fewer answer options; wording changes
8a 12a Wording change(s); time parameter change
8b 12b Wording change(s); time parameter change
8c 12c Wording change(s); time parameter change
13 8 Changes to types of health insurance (before pregnancy)
12a 11a Wording change(s); time parameter change
12b 11b Wording change(s); time parameter change
12c 11f Wording change(s); time parameter change
12f 10 No longer stand-alone question; Wording change(s); time parameter change
12h 11i Wording change(s); time parameter change
14 22 Changes to types of health insurance (during pregnancy)
15 69 Changes to types of health insurance (after pregnancy)
18 16 Wording change(s)
20 18 Wording change(s)
25 23 Wording change(s)
29 28 Wording change(s)
31a 34 No longer stand-alone question
41 40 Changes to number of drinks options
42 41 Changes to number of drinks options
43e 42e Changed to gender neutral partner pronoun
43j 42j Changed to gender neutral partner pronoun
45a 44 No longer stand-alone question
46a 45 No longer stand-alone question; Wording change(s)
46b 45 No longer stand-alone question; Wording change(s)
53.7 53.7 Wording change(s)– separating work
53.8 53.7 Wording change(s)– separating school
56 55 Wording change(s)
57 56 Wording change(s)
64 63 Wording change(s)
65.8 64.6 Wording change(s)
66.1 65.1 Wording change(s)
66.5 65.5 Wording change(s)
66.7 65.8 Wording change(s)
66.8 65.6 Wording change(s)
70 68 Wording change(s)
78 72 Kinds of help mom would have if needed: Answer options changed 
79 76 Changes to income categories