The Thalidomide tragedy has influenced how medicine use during pregnancy is regulated, leading to ethical concerns, cost, and legal risks that prevent many drugs from being tested. Despite societal fears, medication use in pregnancy has increased, with most remaining 'off-label'. Barriers to testing include historical exclusion of pregnant women from trials, unwillingness of drug companies due to ethical and financial risks, and prescriber and patient concerns. Greater investment in trials during pregnancy is needed to ensure safety.