Title V data capacity efforts funded by sources other than SSDI support up to date MCH data and information systems and program activities such as the Title V Block Grant Five-Year Needs Assessment, annual MCH Block Grant performance measure reporting/monitoring, and data-driven programming.

Pregnancy Risk Assessment Monitoring System (PRAMS)

The Centers for Disease Control and Prevention (CDC) PRAMS is a core dataset being used to assess overall state MCH data capacity. Beginning with the 2017 birth cohort, Georgia PRAMS now meets CDC benchmarks for data collection. Prior to the 2017 birth cohort, the most recent Georgia PRAMS data currently available is the 2014 birth cohort, which did not meet the strict response rate cutoff. This means results from the 2014 data should be interpreted with caution and are not available in CDC analyses. Though Georgia submitted data to the CDC for the 2015 birth cohort, the response rate was not high enough to consider the results representative of all Georgia moms who recently gave birth. For the 2016 birth cohort, Georgia was unable to provide a data submission to the CDC for cleaning and weighting purposes as PRAMS operations ceased after pulling the first six batches. Thus, data are not available for the 2016 birth cohort either. A major shift in the responsibility for PRAMS occurred and was transferred to the Maternal and Child Health Epidemiology Section in the Epidemiology Division. Since this time (2017 to 2021 birth cohorts; with 2022 birth cohort nearing completion and 2023 birth cohort about to begin), Georgia PRAMS has had a response rate high enough to achieve results representative of all Georgia women with a recent live birth.

Georgia PRAMS Supplements

Emerging public health threats and issues of importance to maternal and child health may require the use of supplements to the PRAMS questionnaire. Georgia PRAMS has demonstrated the capacity to implement such new survey supplements. During the previous and current project period, Georgia PRAMS implemented the following supplements:

• April 2022-March 2023: A Social Determinants of Health supplement is currently being implemented to ascertain the prevalence and distribution of various determinants of health, like housing stability, food access, transportation mode, health literacy, mental health care access, and discrimination.
• April 2020-present: A Mental Health supplement continues to be implemented as part of a collaboration between Georgia PRAMS and the Office of Women’s Health. Focusing on the time during and shortly after the end of the pregnancy, this supplement is collecting information on communication between health care providers and recent mothers, taking mental health medications, counseling, and depression and anxiety symptoms.
• April 2021-present: An Oral Health supplement continues to be implemented to better understand the oral health problems, treatment, and oral health care access during and shortly after the end of the pregnancy.
• April 2021-March 2022: A Covid-19 vaccination supplement was implemented to assess the sources of vaccination information, vaccination-related behaviors, and vaccination-related attitudes.
• January 2021-March 2021: A Covid-19 supplement was implemented to better understand the impact of Covid-19 on the behaviors and experiences of pregnant and recently postpartum women and their infants, including care-seeking during the pandemic.
• January 2019-April 2021: A Disability supplement was implemented to understand the prevalence of disabilities among women with recent live birth and explore disparities in the prevalence of negative maternal and child health outcomes among women with disabilities.

PRAMS for Dads

In collaboration with Northwestern University and CDC, GA-PRAMS designed and implemented PRAMS for Dads. This pilot project, conducted from October 2018-December 2019 to collect data on the experiences, behaviors and needs of fathers after the birth of a new infant, was intended to assess the most effective method for contacting fathers shortly after the birth of a live infant and to fill a gap in knowledge regarding the experiences and behaviors of new fathers and their role in the health of their families. Sampled fathers were randomized into two groups to receive either: 1) direct outreach (“Direct to Dads”) or 2) outreach through the mother (“Mother as Gatekeeper”). Thus far, the results of the initial implementation have (1) led to a manuscript that examines the strengths of each mode of outreach and (2) multiple conference presentations, both oral and poster. A manuscript detailing this pilot study was published in PLOS One, “Pregnancy Risk Assessment Monitoring System for Dads: A piloted randomized trial of public health surveillance of recent fathers’ behaviors before and after infant birth”. Another manuscript has been accepted for publication in Pediatrics, “Breastfeeding and Infant Sleep Practices: Findings from the PRAMS for Dads Study”. Currently, Georgia PRAMS is preparing for implementing PRAMS for Dads starting in June 2023. This implementation will include methodology changes following the initial implementation, including moving the start date to sooner following the pregnancy, reducing the number of phone calls to each father, and only implementing a protocol similar to the previously implemented “Direct to Dads” approach. 

Examples of PRAMS data used to increase the MCH knowledge base follow:

• 2017-2021 Georgia PRAMS data continue to be used to inform and monitor progress on the MCH Title V Block Grant. Georgia PRAMS provided data points ranging from safe sleep and breastfeeding to mental health and prenatal care. Additionally, to better inform programmatic efforts, Georgia PRAMS provided data on the information recent mothers received from healthcare providers; these indicators were previously not considered as part of the decision-making process.

• 2017 Georgia PRAMS data were used in Healthy Mothers, Healthy Babies Coalition of Georgia (HMHBGA) of Georgia’s “2019 State of the State of Maternal & Infant Health in Georgia” report (https://hmhbga.org/education/toolkits-reports/).

• Provided Center for Oral Health Systems Integration and Improvement (COHSII) with Georgia PRAMS oral health data for inclusion in the “Identifying and Implementing Oral Health Quality Indicators for the Maternal and Child Health Population: 2018–2019” report (2019). Georgia was one of the initial COHSII participants.

• In collaboration with the DPH Chronic Disease, Health Behaviors, and Injury Epidemiology (CHIE) Section’s Occupational Health team, Georgia PRAMS 2017-2019 occupation data were analyzed and were recently disseminated through a presentation examining the relationship between industry and occupation and breastfeeding practices.

• Georgia PRAMS data on safe sleep informed the selection of educational support materials that were distributed to birthing hospitals for parents of newborns to help reinforce the safe infant sleep recommendations provided by the American Academy of Pediatrics. Use of PRAMS data allowed for identification of targeted interventions and guidance for the creation and provision of educational materials.

• As part of a collaboration between DPH’s Oral Health and Chronic Disease programs, PRAMS data were used in the Tobacco Cessation Resource Toolkit for Oral Health Providers (https://www.gaohcoalition.org/resources/for-healthcare-providers/) and publication of two PRAMS infographics on tobacco use and secondhand smoke exposure during pregnancy increasing the proportion of callers to the Georgia Tobacco Quitline referred by oral health providers by 20 percent. (https://dph.georgia.gov/PRAMS).

Birth Defects Registry (BDR)

The Zika pandemic highlighted the need for statewide rapid and ongoing population-level birth defects surveillance. However, Zika-associated birth defect case ascertainment was initially only available in a small catchment area under the purview of CDC’s Metropolitan Atlanta Congenital Defects Program. To address this critical surveillance gap, DPH developed the electronic BDR for rapid, population-based surveillance of birth defects for the entirety of Georgia. The BDR was developed using surveillance guidelines established by the National Birth Defects Prevention Network (NBDPN), from variable selection to the case abstraction tool. The BDR leverages multiple data sources to get at the burden of birth defects among the Georgia population. The COVID-19 pandemic resulted in less resources being available to work on birth defects surveillance. Following the pandemic, MCH EPI has had a renewed focus on the BDR. This focus has centered around two areas: for patients with dates of birth starting in 2016, (1) connecting, validating, and updating a trial HL7 connection to the largest pediatric healthcare system in Georgia (CHOA); and (2) reviewing, validating, and ingesting missed files reported by birthing facilities (GBDRIS). To date, nearly 10,000 unique patients have been reported through this HL7 mechanism (N=9,924 unique patients with 12,388 reports, 32% of total patients in BDR). Currently, GBDRIS files have contributed over 8,000 unique patients to the BDR.

Sickle Cell Disease and Related Hemoglobinopathies

MCH EPI is partnering with the Georgia Health Policy Center on performing population-level surveillance of sickle cell disease and related hemoglobinopathies. This collaboration expands on existing capacity for newborn screening analyses and helps Georgia have a more accurate assessment of the burden of sickle cell disease on the population, including the distribution of cases and potential unmet need among persons with sickle cell disease. Through this collaboration, we worked on assessing COVID-19 infection Outcomes among children living with Sickle Cell Disease and Trait. This led to a manuscript published May 2023 in the Journal of Pediatric Hematology and Oncology entitle, “COVID-19 Infection and Outcomes in Newborn Screening Cohorts of Sickle Cell Trait and Sickle Cell Disease in Michigan and Georgia”. Also, we are working to examine immunization adherence and opioid use among children living with Sickle Cell Disease and Trait.

Georgia Perinatal Quality Collaborative (GaPQC)

Hospital Discharge Data (HDD) is a critical data source for GaPQC programming. Under Georgia law, HDD is collected by the Georgia Hospital Association and transmitted to DPH through the Office of Health Indicators for Planning and DCH on a quarterly basis. The newly established Women’s Health EPI team analyzes HDD to assess severe maternal morbidity for hospitals participating in the AIM Hemorrhage and Hypertension bundles. Preliminary analyses for hospitals participating in the AIM CCOC bundle have also been conducted. EPI’s participation in GaPQC has provided the opportunity to create an initial “rapid cycle” surveillance system of severe maternal morbidity that allows participating facilities to have close to “real time” severe maternal morbidity metrics. To date, severe maternal morbidity outcome measures for the Hemorrhage and Hypertension bundles that use the HDD have been made available to all participating facilities by quarter dating back to Q1 2016. Women’s Health EPI submits all measures (process, structure, and outcome) available on the AIM portal and multiple facility-specific reports that include each measure have been disseminated on a quarterly basis. In turn, the lag time for accessing HDD has decreased from the previous time to obtain annual HDD (18 to 24 months) to the lag time needed to obtain quarterly HDD, four to six months. All quarterly data points have been corrected in the AIM portal to reflect this change. As part of participation in the AIM bundles, Georgia received an award from AIM for data timeliness.

Maternal Mortality Review Committee (MMRC)

The Georgia Maternal Mortality Review Committee (MMRC) receives funding from Title V and the CDC ERASE MM program to increase capacity to complete timely review of pregnancy-associated deaths. During 2022, the MMRC achieved the CDC goal of reviewing all pregnancy-associated deaths within two years of the date of death. Timeliness of data entry has also been improved. Data are abstracted and entered into the Maternal Mortality Review Information Application (MMRIA) database prior to review committee meetings and committee decisions are entered into the database within 30 days of the review meeting. The MMRC staff have also worked to improve timeliness of case confirmation and pregnancy is now confirmed within three months of death identification. Timely case identification has also led to more success with pregnancy checkbox corrections. When a death certificate has an indication of pregnancy within the past year on the pregnancy checkbox but confirmation of pregnancy cannot be found, the certifier is contacted to request a correction on the pregnancy checkbox. This effort improves the data quality of national maternal mortality data. The development of the Women’s Health Epidemiology section (WH EPI) has increased the capacity to analyze and report maternal mortality data.