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2009 CityMatCH Urban MCH Leadership ConferenceValidation of fertility treatment use questions on the 2004 Pregnancy Risk AssessmentMonitoring System surveyPRIMARY CONTACT:Danielle T Barradas, PhDEIS OfficerMCHEPI Team, Division of ReproductiveHealthNCCDPHP, CDC4770 Buford Hwy NE, MS K-22Atlanta, GA, 30341Phone: (770) 488-6286Fax: (770) 488-5291Email: dbarradas@cdc.govCATEGORYPrematurity / Preterm birth / BirthweightOther: data qualityFOCUSData FocusBACKGROUNDCO-PRESENTER(S)/AUTHOR(S):Wanda Barfield, wjb5@cdc.gov (Author)Laura Schieve, ljs9@cdc.gov (Author)Denise D'Angelo, dnd1@cdc.gov (Author)Victoria Wright, vdc4@cdc.gov (Author)Susan Manning, aci6@cdc.gov (Author)Women who conceive with the assistance of fertility treatments are at increased risk of multiple gestationpregnancies and accompanying adverse pregnancy outcomes in addition to low birth weight (LBW, 1500-2499 g) births among singletons. The Pregnancy Risk Assessment Monitoring System (PRAMS) couldhelp state health departments assess outcomes associated with fertility treatments, but a previous studysuggested that PRAMS questions about fertility treatments lacked specificity and substantiallyoverestimated ART use (estimates were 2.6-fold higher than expected) The questions were revised in2004.OBJECTIVESTo assess the validity of the revised PRAMS questions regarding various fertility treatmentsMETHODSWeighted estimates of the prevalence of births conceived using assisted reproductive technology (ART)by age, plurality, and infant birth weight in three PRAMS states (FL, MD, UT) in 2004 were comparedwith corresponding estimates from the National ART Surveillance System (NASS), the current goldstandard for ART use.RESULTSThe estimated number of ART births ascertained from PRAMS was 3,700 (95% confidenceinterval=2,300–5,200), compared to 2,939 ART births reported to NASS. PRAMS and NASS estimates ofmaternal age, plurality, and infant birth weight did not differ. For example, while PRAMS overestimated8
2009 CityMatCH Urban MCH Leadership Conferencethe number of singleton births and LBW singleton births by 33% and 8%, respectively, neither of thesedifferences reached statistical significance.LIMITATIONSStandard errors of the estimates from PRAMS were large, resulting in wide confidence intervals, becausebirths resulting from ART comprised only a small percentage of the PRAMS sample. Additionally, thereare no US population-based reporting systems for the use of non-ART fertility treatments; thus, thevalidity of the PRAMS questions specific to such treatments could not be assessed.CONCLUSIONS/IMPLICATIONSValidity of the PRAMS questions for estimating ART births has greatly improved since the questionrevision; however a slight overestimation remains. Comparisons of outcomes associated with variousfertility treatments should be cautiously interpreted. As states shoulder much of the cost related to adverseoutcomes related to ART, data from PRAMS can be used to describe maternal behaviors and infant carepractices associated with ART use.9
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