Abstract West Virginia Pregnancy Risk Assessment Monitoring System (WV PRAMS) is a joint research project between the West Virginia Office of Maternal, Child and Family Health (WV OMCFH) and the CDC. The project is an on-going, population-based surveillance system designed to identify maternal attitudes and experiences before, during and after pregnancy. Research indicates that maternal behaviors during pregnancy influence infant birthweight and death rates. PRAMS was developed in 1987 by the CDC because (1) infant mortality rates were not declining as rapidly as they had in previous years, (2) the prevalence of low birthweight was showing little change and (3) maternal behaviors such as alcohol and tobacco use and limited use of prenatal care were contributing to the slow rate of decline in both infant mortality rates and low birthweight prevalence. Seeing a need to supplement vital records data in order to help establish and maintain an epidemiologic surveillance system of selected maternal behaviors and experiences, WV was one of the first states to participate in the project. PRAMS provides data not available from other sources about pregnancy and the first few months after birth. The goal of WV PRAMS is to identify maternal risk behaviors that may affect both maternal and infant health. Findings from WV PRAMS are used to enhance the understanding of maternal behaviors and their relationship with adverse pregnancy outcomes. WV OMCFH uses PRAMS surveillance data for program planning and evaluation and changing public health practice and policy for state maternal and child health programs.