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Pregnancy Risk Assessment Monitoring System (PRAMS)
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.
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.
Additional questions were asked on the 2020 survey regarding COVID-19 and experiences with prenatal care, delivery, postpartum care, and infant care which were asked on question #s CV1-CV11. Those questions can be seen here: Maternal COVID-19 Experiences.
| 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 |
