Rates of low birth weight and preterm birth in the United States remain higher than those of other industrialized countries. The influence of fathers during the pregnancy period and the impact they have on birth outcomes represent under-researched areas in the field of maternal and child health.

This study used nationally representative data from the Early Childhood Longitudinal Study - Birth cohort (2001) to explore three lines of research. Approximately 850 children of unmarried residential fathers comprised the analytic sample. First, as several studies have used paternity acknowledgement as a proxy for paternal involvement during the pregnancy, this study tested three fatherhood constructs to determine if they were associated with whether the father's name was listed on the birth certificate. This study then examined if these fatherhood constructs were associated with low birth weight and preterm birth. Two mediating pathways were considered: change in maternal smoking during pregnancy and adequacy of prenatal care. Finally, the influence of state-level paternity establishment rates on the association between fatherhood constructs and father's name on the birth certificate was studied.

The results indicated that paternal history of negative behaviors was associated with the unmarried residential father being named on the birth certificate. Furthermore, children who lived in states with high rates of paternity establishment were more likely to have their father's name on the birth certificate. Paternal prenatal involvement was associated with both an increased chance of receiving adequate prenatal care and a reduced risk of low birth weight. Maternal smoking during pregnancy was reduced when both parents wanted the pregnancy, and not reduced when the father had a history of negative behaviors.

This study supports the conclusion that paternal prenatal involvement is an important area to be considered in the reduction of adverse birth outcomes. Moreover, this study adds to our understanding of some limitations of using the father's name on the birth certificate as a proxy for paternal involvement during pregnancy for unmarried residential fathers. Finally, although mediation was not evident, this study confirms the influential role that unmarried residential fathers play in maternal health behaviors.