The WV Birth Score began in 1984 and was revised in 2007. One part of the form is a score which predicts the top 18% of infants at risk for death in the first year of life. The other components collect information regarding the health of mothers and their infants. Data from the WV Birth Score between 2001 and 2009 reveal that the average smoking rate among mothers was 28.5%. The average maternal tobacco use rate among High Score infants (53.7%) is significantly higher than the average rate among mothers of Low Score infants (23.6%) (p < .0001). Infants born to women who smoked during pregnancy in 2007 weighed 250 grams less than infants of non-smoking women (p < 0.0001). A question on drug exposures during pregnancy reveals that marijuana is the most commonly reported drug on the Birth Score form. Only 5% of the mothers reported using at least one substance during their pregnancy. Smoking rates during pregnancy in WV are among the highest in the nation and lead to higher mortality rates in the infant born to mothers who smoke. Programs to impact smoking and other maternal health issues should be a priority in WV.