INTRODUCTION: Severe racial disparities exist among American women with respect to fetal, neonatal, and maternal outcomes. Few studies have examined the relationship between black women's trust towards physicians and pregnancy outcomes, drug use, or incarceration. METHODS: This project utilizes survey data from the Black Women in the Study of Epidemics Project (NIDA R01-DA011967). IRB approval was obtained. Between 2008–2011, 643 women completed a baseline interview concerning health status and care utilization, including 240 incarcerated women and 197 women on probation. Approximately half reported current drug use. Follow-up interviews occurred at 6-, 12-, and 18-months. Physician trust was measured continuously using a validated 11-item scale (Anderson & Derrick, 1990). Data analysis was performed using mixed models to account for the longitudinal data. RESULTS: Drug use at baseline, current pregnancy, and past history of a birth-related problem were all significantly related to physician trust. Women who had ever experienced a birth-related problem and women who reported drug use at baseline had lower levels of physician trust than women who had not experienced these problems (P<.05). Women who were currently pregnant endorsed a higher level of trust in their physician than women who were not pregnant (P<.05). Baseline incarceration status was not significantly related to physician trust. CONCLUSION: Given the established relationship between high physician trust and favorable patient outcomes, future interventions must address disparities in black women's trust, with specific focus on drug-using women and women with past birth complications. Pregnancy should be considered an opportune time to enhance trust between patient and physician.