This project explores how factors across a mother’s life course contribute to adverse birth outcomes such as preterm birth and low birth weight, and how differences in community resources, individual characteristics, and prior health outcomes might explain population differences in birth outcomes. Specifically, this project considers how changes in risk factors over time may better explain population differences, as many studies have focused only on the impact of exposures during pregnancy on birth outcomes. This proposal will address knowledge gaps by leveraging a unique multigenerational dataset of maternally linked birth certificates from 1989-2020 in South Carolina. Aim 1 examines the intergenerational association between maternal and infant birth outcomes, and heterogeneities in the association. Aim 2 studies the association between intergenerational risk factors and adverse birth outcomes. Aim 3 determines how accounting for such intergenerational risk factors, in addition to generation-specific risk factors, affects the intergenerational association of birth outcomes as well as population differences in that association.