1. Pregnancy Risk Assessment Monitoring System (PRAMS) Survey &
Safe Sleep in South Dakota
Bonny Specker, Maggie Minett, Tianna Beare,
Katelyn Strasser, Linda Ahrendt
South Dakota State University
South Dakota Department of Health
Many of the of infant deaths following hospital discharge are related to unsafe sleep practices. What I would like to talk about today is the…

2. South Dakota PRAMS-like Survey
Established by the CDC in 1987 to obtain information about maternal behaviors & experiences that may be associated with adverse birth outcomes.
South Dakota Department of Health conducted their first statewide PRAMS-like survey in and repeated it in 2016 (following CDC protocol with slight modifications).
In 2017, South Dakota began participating in the CDC PRAMS.

3. South Dakota PRAMS-like Survey
“I think it’s awesome that there are surveys out here that are made to help the health of new moms and babies.”
A random sample of South Dakota mothers who gave birth is selected from birth certificate files.
American Indian & other race mothers are oversampled to ensure sufficient numbers to obtain reliable estimates.
Weighting the data based on sampling strategy and non-response allows for calculation of statewide rates.

4. South Dakota PRAMS-like Survey
In 2014 & 2016:
Excellent response rates – 71% & 68% *
∼10% of all eligible South Dakota mothers giving birth (n≈11,500) completed the survey in both years
* In 2013, only 27/41 (66%) of CDC-funded states achieved response rates of >60%

5. South Dakota PRAMS-like Survey
Before Pregnancy:
Health Insurance & Access to Services
Preconception Care & Topics Discussed Prior to Pregnancy
Intendedness of Pregnancy
During Pregnancy:
Prenatal Care
Substance Use during Pregnancy
Maternal Health during Pregnancy
After Pregnancy:
Breastfeeding & Infant Sleep
Postpartum Health
Stress, Social Supports & Domestic Abuse

6. South Dakota PRAMS-like Survey PRAMS-like Survey Question
2016 AAP Recommendations: 4 of the PRAMS questions applicable to these recommendations
AAP Recommendation
PRAMS-like Survey Question
Back to sleep for every sleep.
In which one position do you most often lay your baby down to sleep?
Room-sharing with the infant on a separate sleep surface is recommended.
When your baby sleeps alone, is his or her crib or bed in the same room where you sleep?
Room-sharing with the infant on a separate sleep surface is recommended.
In the past 2 weeks, how often has your new baby slept alone in his or her own crib or bed?
Keep soft objects and loose bedding away from the infant’s sleep area.
Tell us how your new baby most often slept in the past 2 weeks…
With a blanket
With toys, cushions, or pillows…
With crib bumper pads

7. 2016 PRAMS-like Survey: Safe Sleep
Most Often Position the Infant is Laid Down to Sleep by Race and Year* (weighted)
* Significant race differences
^ In 2014, 1.9% stated multiple positions

8. 2016 PRAMS-like Survey: Safe Sleep
Room-sharing When the Infant Slept Alone by Race* (weighted)
* Significant race differences

9. 2016 PRAMS-like Survey: Safe Sleep
How Often Infant Sleeps in His or Her Own Crib or Bed
by Race * (weighted)
* Significant race differences

10. 2016 PRAMS-like Survey: Safe Sleep
How Infants Slept in the Past Two Weeks by Race
(weighted; check all that apply)
55.3% of South Dakota infants sleep WITH soft objects or loose blankets.
No significant race differences

11. 2016 PRAMS-like Survey: Safe Sleep
How Infants Slept in the Past Two Weeks by Race
(weighted; check all that apply)
* Significant race differences

12. Safe Sleep & Healthcare Providers
Percent of mothers who put their infant to sleep on their back by whether her healthcare provider talked to her about the importance of putting her infant to sleep on their back:
Not significantly different

13. Safe Sleep & Healthcare Providers
Percent of mothers whose infant sleeps in the same room as the mother when infant sleeps alone by whether her healthcare provider talked to her about placing the infant’s crib in the mother’s room:
Significantly different, p<0.001

14. Safe Sleep & Healthcare Providers
Percent of infants who always sleeps alone by whether the healthcare provider talked to the mother about the importance of their infant sleeping in a crib, bassinet or pack-n-play:
Not significantly different

15. Safe Sleep & Healthcare Providers
Percent of infants who sleep in an area free of objects by whether the healthcare provider talked to the mother about what should & should not go in the baby’s bed:
Significantly different, p=0.04

16. AAP Safe Sleep Recommendations
South Dakota Populations Least Likely to Meet 2016 AAP Recommendations
AAP Recommendation
At-risk Populations
Back to sleep for every sleep.
91.7% meet recommendation
Mothers of other races
Hispanic mothers
Young mothers
Less than a high school education
Household income of $15-26,000 per year

17. AAP Safe Sleep Recommendations
South Dakota Populations Least Likely to Meet 2016 AAP Recommendations
AAP Recommendation
At-risk Populations
Room-sharing with the infant on a separate sleep surface is recommended.
71.0% meet recommendation
White mothers
More than a high school education
Married mothers

18. AAP Safe Sleep Recommendations
South Dakota Populations Least Likely to Meet 2016 AAP Recommendations
AAP Recommendation
At-risk Populations
Room-sharing with the infant on a separate sleep surface is recommended.
37.2% meet recommendation
American Indian mothers & mothers of other races
Less than a high school education
Not married
Household income of $15,000 or less per year

19. AAP Safe Sleep Recommendations
South Dakota Populations Least Likely to Meet 2016 AAP Recommendations
AAP Recommendation
At-risk Populations
Keep soft objects and loose bedding away from the infant’s sleep area.
44.7% meet recommendation
Younger mothers
Not married mothers
Household income of $15-26,000 per year

20. AAP Safe Sleep Recommendations
SUMMARY: We have a lot to do to educate South Dakota mothers on safe sleep practices.
Number of AAP Sleep Recommendations Met by Race* (weighted)
* Significant race differences

21. SUMMARY: Safe Sleep
Bed-sharing and sleeping with soft objects or loose blankets are two major areas of concern.
Mothers listen to what their healthcare providers are saying, especially with regard to room-sharing and what does or does not belong in a crib.
Only 11% of South Dakota mothers in followed all four of the recommendations that were investigated.

22. South Dakota Department of Health Safe Sleep
Ongoing programs:
Cribs for kids program
Education for WIC mothers
Other components to Safe Sleep Recommendations:
Breastfeeding support
Tobacco cessation program for pregnant women
Check out the resources at the DOH table