Preterm-low-birthweight births comprise a subset of extremely high-risk low-birthweight infants. While numerous studies have evaluated risk factors to predict an individual's chance of a high-risk pregnancy, few have identified risk factors specifically related to preterm-low-birthweight births. Risk factors for preterm-low-birthweight births were analyzed in a sample of 11,623 women from northwest North Carolina enrolled in a low-birth-weight prevention program. Significant risk factors for preterm-low-birthweight births in this population were identified, and weights were assigned to each factor. Application of the weighting system to each patient's specific risk factors identifies women at high risk for a preterm-low-birthweight birth and assists in the determination of appropriate intervention. These data make use of all current information in the low-birthweight births prevention project. Prospective assessment of the scoring system as the project continues should improve the ability to identify and intervene with women at highest risk for a preterm-low-birthweight birth.