Pharmacological treatment during pregnancy must be guided by a thorough assessment of maternal health status, therapeutic necessity, and potential fetal risks. Assessing teratogenic risk, in particular, requires careful consideration of several factors, including the timing of exposure during gestation, dosage, duration of therapy, and the likelihood of drug interactions. A comprehensive risk assessment should incorporate multiple factors, such as placental drug transfer, maternal pharmacokinetic changes during pregnancy, and a detailed patient history, including personal and familial anamnesis, previous pregnancies with congenital anomalies, genetic predisposition, and lifestyle-related risks. Risk assessment is guided by drug pregnancy categories and up-to-date information from teratology databases. Considering the adverse effects of untreated maternal disease on both mother and fetus, when pharmacotherapy is indicated, the lowest effective dose for the shortest possible duration should be preferred. This comprehensive and multidisciplinary approach ensures safe medication use during pregnancy and the protection of maternal and fetal health.