HONOLULU -- Hawaii earns a harsh grade when it comes to premature births.

According to an annual report card by the March of Dimes, Hawaii's premature birth rate of 12.4 percent rates a D.

It is the second year in a row Hawaii received a D.

The March of Dimes graded states by comparing rates of premature birth to the national goal of 7.6 percent or less by 2010.

However, Hawaii has earned a star for reducing the percentage of women of child-bearing age who smoke and who are uninsured.

As of 2008, no state has earned an "A" and only Vermont earned a "B."