Medication use during pregnancy presents complex clinical dilemmas. Physicians must balance the imperative of treating maternal disease against the risk of adverse fetal outcomes. This review critically analyzes the pharmacokinetics of drugs in pregnancy, placental transfer, and the teratogenic potential of common medications. Emerging evidence from clinical studies and experimental models underscores the importance of individualized prescribing practices. Special attention is given to analgesics, antimicrobials, anticonvulsants, anticoagulants, and non-therapeutic substances. The review concludes with evidence-based recommendations to guide clinicians in minimizing fetal risks while ensuring adequate maternal care.