The National Association of Chronic Disease Directors (NACDD) is a public health association for chronic disease program directors of each state and U.S. territory. Since its founding in 1988, NACDD has been a national leader in the effort to reduce chronic diseases by mobilizing its members to advocate for preventive policies and programs, encourage knowledge sharing and develop model partnerships for health promotion through state and community-based prevention strategies.
 
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Using PRAMS for Chronic Disease Prevention
 
MCH-Chronic Disease Collaboration Project
 
 
Using PRAMS (Pregnancy Risk Assessment Monitoring System) for Chronic Disease Prevention and Health Promotion
The Women's Health Council, CDC's Division of Reproductive Health (DRH), and the Association of Maternal Child Health Programs (AMCHP) are partnering on a new initiative using PRAMS data to "link" chronic disease and health promotion programs with maternal child health (MCH).
 
 
 
 
 
 
 
 
 
 
 
 
 



What is PRAMS?

PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy, as well as pregnancy outcomes. Information is obtained about chronic disease conditions such as hypertension, diabetes, smoking, overweight/obesity, and in a few states, asthma. For more details, visit: www.cdc.gov/prams  

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Does Every State Have a PRAMS Program?

Currently, thirty-seven states, New York City, and South Dakota (Yankton Sioux Tribe) currently participate in PRAMS. Six other states previously participated. To see US map of programs and link directly to your state PRAMS website, click http://www.cdc.gov/prams/states.htm.

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Are Other States Collaborating?

The current level of program collaboration is low for key chronic disease indictors. A recent survey conducted with chronic disease, health promotion , MCH and/or PRAMS program directors indicated that less than 15% of all respondents were collaborating to use PRAMS diabetes, hypertension or obesity data, even though all are areas of interest and expertise for chronic disease programs. Use of maternal smoking data was highest, at 74%. For more information, contact Joan Ware at ware@chronicdisease.org.

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How Can Chronic Disease Programs Use PRAMS Data?

1. Identify a target population (women of child-bearing age, preconception) for prevention services (especially in diabetes prevention and control, and obesity management) to enable them to enter pregnancy in optimal health.

Recommendations to Improve Preconception Health and Health Care—United States: A Report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm

“Over the next several decades, more and more women of reproductive age will have type 2 diabetes. This is going to be a major health crisis when dealing with pregnant women.” Hampton T. Maternal Diabetes and Obesity May Have lifelong Impact on Health of Offspring. JAMA, 2004: Vol 292, No. 7, pp789-790.

“Longer duration of breastfeeding was associated with reduced incidence of type-2 diabetes. Lactation may reduce risk of type-2 diabetes in young and middle-aged women by improving glucose homeostasis.” Stuebe A, et al. Duration of Lactation and Incidence of Type 2 Diabetes. JAMA, 2005: Vol 294, No 20, pp 2601-2610.

2. Identify a new at-risk population for early intervention
“The physiologic changes of pregnancy can reveal risk of chronic diseases. Exaggerated responses reflective of the metabolic syndrome are seen in pre-eclampsia and gestational diabetes and can herald future cardiovascular and metabolic disease. Pregnancy is therefore an important screening opportunity for cardiovascular and metabolic disease risk factors, with the possibility of early intervention.” Kaaja, RJ, Greer IA. Manifestations of Chronic Disease During Pregnancy. JAMA, 2005; 294:2751-2757.

3. Use data as part of chronic disease prevention (including obesity) planning
“As the obesity epidemic unfolds on a global state, two new groups of patients are in the spotlight: pregnant women and their developing offspring. Recent research links maternal obesity as well as type 2 diabetes to a spectrum of abnormal conditions that occur during fetal development. Many of these effects, such as fetal obesity and neural tube defects, can have lifelong repercussions.” Hampton T. Maternal Diabetes and Obesity May Have lifelong Impact on Health of Offspring. JAMA, 2004: Vol 292, No. 7, pp789-790.

“Recent research suggests that prenatal characteristics, particularly race, ethnicity, maternal smoking during pregnancy, and maternal pre-pregnancy obesity, exert influence on the child’s weight states through an early tendency toward overweight, which then is perpetuated as the child ages. This finding suggests that overweight prevention may need to begin before pregnancy and in early childhood.” Salsberry P, and Reagan PB. Dynamics of Early Childhood Overweight. Pediatrics, 2005: Vol. 116, No 6, 1329-1341.

4. Partner with Maternal Child Health programs to develop health promotion programs and prevent adverse birth outcomes
“Infants have an increased risk for birth defects when they are borne by women with diabetes. In addition, type 2 diabetes appears to carry an especially high risk, with miscarriage and congenital malformations almost twice that seen in type 1 diabetes. The risks for both mother and child are even greater if the mother was obese before pregnancy.” Hampton T. Maternal Diabetes and Obesity May Have lifelong Impact on Health of Offspring. JAMA, 2004: Vol 292, No. 7, pp789-790.

5. Partner with PRAMS programs to develop state questions about chronic disease prevention and health promotion to provide data needed for planning and assessing health programs and policy.

6. Build state capacity to collect, analyze, and translate data to address relevant public health issues by comparing and contrasting data collections that complement PRAMS data, such as the Behavioral Risk Factor Surveillance System (BRFSS).

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How Have Other States Used PRAMS Data?

From Data to Action: Using Surveillance to Promote Public Health
http://www.cdc.gov/prams/dataAct2002/PDF/data_to_action_2002.pdf  

D’Angelo D, Colley Gilbert B, editors. From Data to Action: Using surveillance data to promote public health action. Atlanta, GA: Division of Reproductive Health, National Centers for Chronic Disease Prevention and Health Promotion; 2002.

Carmichael SL, Ahluwalia IB, The PRAMS working group. Correlates of postpartum smoking relapse: results from the Pregnancy Risk Assessment Monitoring System. Am J Prev Med 2000; 19:193–6.

Coleman GJ, Joyce T. Trends in smoking before, during and after pregnancy in ten states. Am J Prev Med 2003; 24(1):29–35.

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Tobacco Prevention

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Overweight/Obesity, Body Mass Index (BMI) 

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Diabetes

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Injury Prevention

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Hypertension

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Breastfeeding (An intervention for chronic disease prevention)

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Who Can I Contact for More Information?

For information about the CDC Pregnancy Risk Assessment System please visit: www.cdc.gov/prams  

For individual state contacts please visit: http://www.cdc.gov/prams/states.htm (Then click on either your state on the US Map, or on the state name in the listing under the map.)

For more information about the MCH Linkages Collaboration Projects with chronic disease, health promotion and PRAMS programs, contact:

Normie Morin Voillequé
NACDD Women’s Health Council
Project Lead
Phone: 303-692-2505
Fax: 303-691-7721
E-mail : Normie.morin@state.co.us  

Joan Ware
NACDD Women’s Health Council
Program Consultant
Phone: 801-277-2353
Fax: 801-277-2353
E-mail: ware@chronicdisease.org

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