Pregnancy Risk Assessment Monitoring System (PRAMS)

PRAMS and . . .

Postpartum Depression Postpartum Depression

Depression among mothers in the months after 

delivery has surfaced as an important maternal and

child health concern. Data from three states indicate

that nearly 12% of women reported being moderately

depressed after they delivered their baby, and 6%

reported being very depressed after delivery.1 In 

addition to directly influencing the emotional wellbeing of mothers, postpartum depression (PPD) 

has been shown to affect marital relationships, 

mother–infant bonding, and infant behavior.1–4

PRAMS and Self-Reported Postpartum

Depression 

Data from the Pregnancy Risk Assessment Monitoring

System (PRAMS) can be used to estimate the prevalence of self-reported postpartum depression

(SRPPD*) and identify trends in and risk factors for

SRPPD. PRAMS data can also be used to monitor

progress toward meeting the Healthy People 2010

developmental objective to reduce PPD.5

In 2000, seven states (Alaska, Louisiana, Maine, New

York, North Carolina, Utah, and Washington) collected

information about SRPPD using PRAMS† (Figure 1).

The following analysis is based on responses to the

question, “In the months after your delivery, would you

say that you were a) not depressed at all, b) a little

depressed, c) moderately depressed, d) very depressed,

or e) very depressed and had to get help?” The responses were collapsed into three depression categories: none

(a), low to moderate (b or c), and severe (d or e).

Figure 1 shows the 22 states that participated in

PRAMS in 2000. In April 2001, 10 additional states

or areas joined the PRAMS surveillance system:

Maryland, Minnesota, Mississippi, Montana, New

Jersey, North Dakota, Oregon, Rhode Island, Texas,

and New York City.

PRAMS Data on Self-Reported

Postpartum Depression

In 2000, the percentage of PRAMS respondents 

with severe SRPPD ranged from 5.1% in Washington

to 8.9% in Louisiana; the percentage with low to

moderate depression ranged from 48.9% in New

York to 62.3% in Utah; and the percentage with no

depression ranged from 31.0% in Utah to 44.6% 

in New York (Table 1). 

* CI=95% confidence interval

† Data do not include New York City

These data represent the responses of 453,186 women

who gave birth to a live infant in these seven states in

2000; overall, 7.1% (32,176) reported severe depression

after delivery and more than half (233,844) reported

low to moderate depression. Women with fewer than

12 years of education, those who were Medicaid recipients, and those who delivered low-birth-weight babies

WV

ME

NC

SC

FL

AL GA

AR OK

NE

CO

HI

WA

AK

OH

VT *excluding

 New York City

MI

IL

LA

NM

UT

NY*

*Because the question used in PRAMS does not correspond to a clinical definition or diagnosis of depression, we refer to this

measure as SRPPD rather than PPD.

†The Pregnancy Risk Assessment Monitoring System (PRAMS) is part of CDC’s program to reduce rates of infant mortality and

low birth weight. PRAMS is an ongoing state-level, population-based surveillance system that identifies and monitors selected

maternal experiences and behaviors before, during, and after pregnancy. Each state uses the same standardized protocol that

involves a mail questionnaire with telephone follow-up to survey mothers who recently gave birth. Responses are then weighted

to be representative of all women who gave birth in each state during that year. 

PRAMS states with depression question

PRAMS states without depression question

Figure 1. PRAMS States in 2000

Table 1. Prevalence of Three Levels of Self-Reported

Postpartum Depression in Seven PRAMS States, 2000

None

%

(CI)*

Low to

Moderate

%

(CI)*

Severe

%

(CI)*

Alaska 39.8 

(36.9-42.7)

54.9 

(51.9-57.8)

5.4 

(4.1- 6.7)

Louisiana 40.8 

(38.3-43.3)

50.3 

(47.7-52.9)

8.9 

(7.4-10.4)

Maine 41.4 

(38.2-44.7)

50.8 

(47.5-54.1)

7.7 

(5.9- 9.5)

New York† 44.6 

(41.1-48.2)

48.9 

(45.3-52.5)

6.5 

(4.7- 8.3)

North

Carolina

42.2 

(39.1-45.2)

49.4 

(46.3-52.5)

8.5 

(6.7-10.2)

Utah 31.0 

(28.1-34.0)

62.3 

(59.3-65.4)

6.7 

(5.1- 8.2)

Washington 41.0 

(37.6-44.5)

53.8 

(50.3-57.3)

5.1 

(3.8- 6.5)
To learn more or to order copies of this publication, write or call—

Centers for Disease Control and Prevention  4770 Buford Highway NE, Mailstop K-22  Atlanta, GA 30341-3717

Telephone: 770-488-6260  Internet site: www.cdc.gov/reproductivehealth/srv_prams.htm  June 2004

* Alaska, Louisiana, Maine, New York, North Carolina, Utah, and Washington

† CI = 95% confidence interval

‡ The four types of stress were defined as follows:

emotional—a very sick family member had to go into the hospital or 

someone close to the respondent died; 

partner-related—the respondent separated or divorced from her 

husband/partner, she argued more than usual with her husband/partner, 

or her husband/partner said he didn’t want her to be pregnant; 

financial—the respondent moved to a new address, her husband/partner 

lost his job, she lost her job, or she had a lot of bills she couldn’t pay;

traumatic—the respondent was homeless, she was involved in a physical 

fight, she or her husband/partner went to jail, or someone close to her 

had a problem with drinking/drugs

were most likely to report severe depression. In addition,

women who experienced physical abuse during pregnancy and

women who reported emotional, partner-related, financial, or

traumatic stress were more likely than other women to report

being severely depressed (Table 2).

Because more than half of new mothers reported being

depressed, health care providers should speak with their

patients about PPD during prenatal care and well-baby visits.

Recommendations

In Guidelines for Perinatal Care,

7 the American Academy of

Pediatrics and the American College of Obstetricians and

Gynecologists recommend that

• Pregnant women be educated about PPD during the

third trimester.

• Obstetricians/gynecologists consult with their patients

about their risk for psychiatric illness during the 

postpartum period.

Sources of Information

1. Gross KH, Wells CS, Radigan-Garcia A, Dietz PM.

Correlates of self-reports of being very depressed in the

months after delivery: results from the Pregnancy Risk

Assessment Monitoring System. Matern Child Health J

2002;6(4):247-53.

2. Kumar R, Robson KM. A prospective study of emotional

disorders in childbearing women. B J Psychiatry

1984;144:35-47.

3. Murray L, Fiori-Cowley A, Hooper R, Cooper P. The impact

of postnatal depression and associated adversity on early

mother-infant interactions and later infant outcome. Child

Dev 1996;67(5):2512-26.

4. Field T. Maternal depression effects on infants and early

interventions. Prev Med 1998;27(2):200-3.

5. U.S. Department of Health and Human Services. Healthy

People 2010. 2nd ed. With Understanding and Improving

Health and Objectives for Improving Health. 2 vols.

Washington, DC: U.S. Government Printing Office, 2000.

6. Ahluwalia IB, Merritt R, Beck LF, Rogers M. Multiple

lifestyle and psychosocial risks and delivery of small for

gestational age infants. Obstet Gynecol 2001;97:649-56.

7. American Academy of Pediatrics and American College of

Obstetricians and Gynecologists. Guidelines for Perinatal

Care, 5th ed. Washington, DC: American Academy of

Pediatrics, 2002.

Acknowledgments

Brooke Kinniburgh, Brian Morrow, Leslie Lipscomb, 

and the PRAMS Working Group

Table 2. Prevalence of Three Levels of Self-Reported Postpartum

Depression Among PRAMS Participants in Seven States,* by

Selected Demographic Characteristics and Risk Factors, 2000

None

% (CI)†

Low to Moderate

% (CI)†

Severe

% (CI)†

Overall 41.3 (39.8-42.8) 51.6 (50.1-53.1) 7.1 (6.4-7.9)

Age (years)

<20

20-24

25-34

35+

34.0 (29.6-38.3)

37.5 (34.6-40.4)

43.2 (41.1-45.2)

47.0 (42.9-51.2)

57.1 (52.5-61.7)

52.4 (49.4-55.4)

51.0 (49.0-53.1)

47.6 (43.5-51.8)

8.9 (6.4-11.4)

10.0 (8.2-11.9)

5.8 (4.9-6.7)

5.3 (3.4-7.3)

Race 

White

Black

Other

41.1 (39.4-42.8)

42.2 (38.6-45.7)

39.2 (34.0-44.4)

52.3 (50.5-54.0)

48.3 (44.7-52.0)

52.1 (46.9-57.3)

6.6 (5.8-7.4)

9.5 (7.4-11.6)

8.7 (5.9-11.6)

Hispanic ethnicity

Yes

No

44.9 (39.8-50.0)

40.3 (38.7-41.9)

46.7 (41.6-51.7)

52.6 (51.0-54.2)

8.4 (5.7-11.2)

7.1 (6.3-7.9)

Education

<12 years

12 years

>12 years

39.0 (35.3-42.7)

39.2 (36.6-41.8)

43.3 (41.2-45.4)

50.7 (46.9-54.4)

52.7 (50.1-55.4)

51.3 (49.2-53.4)

10.3 (8.1-12.5)

8.0 (6.6-9.4)

5.4 (4.4-6.3)

Medicaid recipient

No

Yes

43.4 (41.5-45.3)

37.8 (35.4-40.2)

51.6 (49.7-53.5)

51.7 (49.2-54.1)

5.0 (4.2-5.9)

10.5 (9.1-12.0)

Infant birth weight

<2500g

>2500g

34.9 (32.0-37.7)

41.7 (40.1-43.2)

53.7 (50.7-56.7)

51.5 (49.9-53.1)

11.4 (9.8-13.1)

6.8 (6.0-7.6)

Physical abuse

during pregnancy

Yes

No

16.2 (11.6-20.8)

42.6 (41.0-44.1)

61.9 (55.1-68.7)

51.0 (49.5-52.6)

21.9 (15.8-28.0)

6.4 (5.7-7.1)

Stress during

pregnancy‡ 6

Emotional

Yes

No

36.9 (34.4-39.4)

43.7 (41.9-45.6)

54.1 (51.5-56.6)

50.2 (48.3-52.0)

9.0 (7.6-10.5)

6.1 (5.2-7.0)

Partner-related

Yes

No

28.8 (26.4-31.1)

47.9 (46.1-49.7)

57.6 (55.1-60.2)

48.4 (46.5-50.2)

13.6 (11.8-15.3)

3.8 (3.1-4.5)

Financial

Yes

No

34.9 (33.0-36.9)

48.7 (46.5-50.9)

55.1 (53.1-57.2)

47.4 (45.2-49.6)

9.9 (8.7-11.2)

3.9 (3.1-4.7)

Traumatic

Yes

No

30.7 (27.5-33.9)

44.0 (42.3-45.6)

54.3 (50.8-57.7)

50.8 (49.2-52.5)

15.0 (12.6-17.5)

5.2 (4.5-5.9)