INTRODUCTION: 8.2% of pregnancy-associated deaths are attributable to opioid use. In Delaware, the rate of overdose deaths is 60% higher than nationally, and 12/14 pregnancy-associated deaths in 2021 were opioid related. This study examines demographic trends to identify targets for population-level interventions to decrease opioid abuse in pregnancy. METHODS: The data for this retrospective study were obtained via chart review, de-identified, and included all women with a positive drug screen who delivered in a Delaware community hospital between January 2018 and December 2021, examined for trends by half year. RESULTS: The majority of 677 women identified as White (70.9%), non-Hispanic/Latino (93.6%), and had government-issued insurance (86.6%). We saw high rates of emergency department (ED) utilization, with 66.6% of patients being seen in ED on at least one occasion prior to delivery. 33% of patients had less than five prenatal visits and 11.1% had no prenatal care. Women with government-issued insurance were significantly more likely to have insufficient prenatal care (P<.001). A trend was present showing that women taking medication for opioid use disorder (MOUD) were more likely to have sufficient prenatal care, although this value was not significant (P=.10). CONCLUSION: Because of frequent visits in the antepartum period, pregnancy is a time where women may have increased interaction with the health care system, providing an important opportunity for intervention and care. Encounters in the ED may provide an important occasion to help connect patients to prenatal care resources, and clinics providing substance use-related care and prenatal care in one location would further decrease barriers to access care.