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Abstract Background Little is known about opioid overdose or naloxone access among pregnant women. Objectives The objectives of this study were to determine the prevalence of non-fatal overdose, risk factors for overdose, and naloxone access among third trimester women in treatment for opioid use disorder. Methods We collected baseline data from a case management parental-support intervention study. To explore the association of variables with past year overdose, we used Wilcoxon rank-sum test, Chi square or Fisher’s exact tests. Results Among 99 participants, 14% (95% CI 7–21%) reported past year overdose and 67% (95% CI 57–76%) had received overdose education and a naloxone kit. Younger age was the only variable associated with past year overdose. Conclusions In this sample, past year non-fatal overdose was common, younger age was a risk factor, and most participants had received a naloxone kit. Further work is needed to understand whether younger age is a risk factor in the general population of pregnant women with opioid use disorder and to identify other potential risk factors for overdose in this population.