Abstract
BackgroundMany European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. PRAMS is a CDC surveillance program which was established in the United States in 1987 to generate high quality, population based data to reduce infant mortality rates and improve maternal and infant health. PRAMS is the only on-going population based surveillance system of maternal behaviours and experiences that occur before, during and after pregnancy worldwide.MethodsThe objective of this study was to adapt, test and evaluate a modified CDC PRAMS methodology in Ireland. The birth certificate file which is the standard approach to sampling for PRAMS in the United States was not available for the PRAMS Ireland study. Consequently, delivery record books for the period between 3 and 5 months before the study start date at a large urban obstetric hospital [8,900 births per year] were used to randomly sample 124 women. Name, address, maternal age, infant sex, gestational age at delivery, delivery method, APGAR score and birth weight were manually extracted from records. Stillbirths and early neonatal deaths were excluded using APGAR scores and hospital records. Women were sent a letter of invitation to participate including option to opt out, followed by a modified PRAMS survey, a reminder letter and a final survey.ResultsThe response rate for the pilot was 67%. Two per cent of women refused the survey, 7% opted out of the study and 24% did not respond. Survey items were at least 88% complete for all 82 respondents. Prevalence estimates of socially undesirable behaviours such as alcohol consumption during pregnancy were high [>50%] and comparable with international estimates.ConclusionPRAMS is a feasible and valid method of collecting information on maternal experiences and behaviours during pregnancy in Ireland. PRAMS may offer a potential solution to data deficits in maternal health behaviour indicators in Ireland with further work. This study is important to researchers in Europe and elsewhere who may be interested in new ways of tailoring an established CDC methodology to their unique settings to resolve data deficits in maternal health.
Highlights
Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy
A significant proportion of other adverse pregnancy outcomes such as pre-eclampsia are associated with pre-existing maternal conditions such as high body mass index (BMI) and high blood pressure that are modifiable by maternal behaviour change [3]
The Pregnancy Risk Assessment Monitoring System (PRAMS) surveillance system is a unique behavioural surveillance initiative around the time of pregnancy which may offer a potential solution for European countries experiencing deficits in high quality, population based data on maternal behaviours and experiences during pregnancy which can only be obtained through maternal self-report
Summary
Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. A significant proportion of other adverse pregnancy outcomes such as pre-eclampsia are associated with pre-existing maternal conditions such as high BMI and high blood pressure that are modifiable by maternal behaviour change [3]. Research has shown that these conditions are a significant cause of morbidity and mortality at birth but are associated with adverse health outcomes throughout the life course [4]. Low birth weight infants are at increased risk of high blood pressure in adulthood [5], type 1 [6] and type 2 diabetes [7], overweight [8], and all-cause mortality including death from cancer and heart disease [9]. Surveillance of behaviour and experiences during pregnancy is essential for improving current maternal and infant health as well as long term population health
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