Speaking at the Physicians Refresher Conference held in Cape Town during Februry 2018, Dr Sinxadi begins her presentation by stating that optimal medicine use in pregnancy means the maintenance of good health outcomes for both the mother and the baby. She adds that child bearing age in South Africa has been categorised as between 10 to 54 with the majority between the ages of 20-29. Dr Sinxadi reminds us of the effects of Thalidomide and how it changed the way medications are regulated for during pregnancy. She adds that it is not only the potential for abnormalities that should be considered, but also the physiological changes affecting pharmacokinetics (PK) during pregnancy. Dr Sinxadi stresses the need for proper assessment of the risk to mother and risk to the fetus before prescribing and adds that only absolutely necessary drugs should be taken during pregnancy. Dr Sinxadi discusses the challenges in prescribing in pregnancy and about general prescribing principles and considerations for prescribing during lactataion. She provides information on the FDA risk categories and on new labelling regulations.