Introduction: Physiological alterations during pregnancy as well as the bio- conversion of compounds can significantly influence the teratogenic effects of drugs and chemicals by affecting absorption, body distribution, the active form(s), and excretion of the compound. Certain medications may cause harm to the foetus due to their potential teratogenic effects and the physiological adjustments occurring in the mother during pregnancy. Prescription of drug used by pregnant women should be viewed as one of a public health issue. This study aware health care workers on harmful drugs prescription to pregnant women and helps in understanding the type of medication used during pregnancy and safety of drugs used during pregnancy, thereupon this study was ascertain drug usage pattern and potential teratogenicity risk among pregnant women attending maternal and child health clinic of Mettu Karl Referral Hospital. Methods: A hospital-based cross-sectional study design was carried out from April 13/2021 to June 15/2021. Data was collected through employing semi-structured questioner, and then the collected data was cleared, coded and analyzed by statistical packages for social sciences 25.0 version statistical software. Descriptive statistics were used to describe the data. P value <0.05 was considered as a cut point for statistical significance in the final model. Results: A total of 156 participants were interviewed of whom, 81(51.9%) pregnant women were age between 20-35 years old and a majority 113(72.4%) of them were married. Among medical condition majority 40(25.6%) of the participants had peptic ulcer disease and 26(16.7%) urinary tract infections followed by 20(12.8%) acute illness and 12(7.7%) hyperemesis. Among the total drug prescribed for pregnant women 30(19.2%) FDA category C was the common followed by 29 (186%) FDA category B and 26(16.7%) FDA category D. Only 10(6.4%) of prescribed drug were FDA category X. Pregnant women whose age >35 years (AOR=4.05, 95%CI:1.274-1.903; p=0.001), urban residents (AOR=2.72, 95%CI:2.524-3.927; p=0.035), and pregnant women during second trimester (AOR=1.79, 95%CI:3.926-9.406; p=0.013) were significantly associated with MCH follow up. Conclusion and recommendation: From the drug prescribed, majority of pregnant women were taken antibiotics followed by 18(11.5%) NSAID, iron sulfate, and proton pump inhibitors. Among the dosage form, above half of the participants were taken the tablet dosage form followed by capsule and gels dosage form. Health care workers should have to brought good care for pregnant women, since they perhaps vulnerable to drug teratogenesity