Pregnancy MCQs With Answer

Pregnancy MCQs With Answer for B.Pharm students provides a focused review of pregnancy pharmacotherapy, maternal-fetal pharmacokinetics, and teratogenic risks. This concise, keyword-rich introduction covers drug transfer across the placenta, physiological changes in pregnancy, common teratogens, safe prescribing principles, and evidence-based management of maternal conditions. Designed specifically for pharmacy undergraduates, these Pregnancy MCQs help reinforce clinical decision-making, dosing adjustments, and risk–benefit assessment in pregnancy. Use this resource to strengthen exam preparation and practical knowledge relevant to obstetric pharmacology, pregnancy safety, and drug counseling. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which mechanism primarily determines passive transfer of most drugs across the placenta?

• Active transport via P-glycoprotein
• Facilitated diffusion through ion channels
• Passive diffusion dependent on lipophilicity and unbound fraction
• Endocytosis by syncytiotrophoblast

Correct Answer: Passive diffusion dependent on lipophilicity and unbound fraction

Q2. During which gestational period is the embryo most susceptible to structural teratogens?

• Pre-implantation (week 1)
• Organogenesis (weeks 3–8)
• Fetal period (weeks 9–38)
• Periconceptional only

Correct Answer: Organogenesis (weeks 3–8)

Q3. Which physiological change in pregnancy most increases renal elimination of renally cleared drugs?

• Decreased hepatic blood flow
• Increased plasma albumin concentration
• Increased glomerular filtration rate (GFR)
• Reduced cardiac output

Correct Answer: Increased glomerular filtration rate (GFR)

Q4. Which anticoagulant is considered safe in pregnancy because it does not cross the placenta?

• Warfarin
• Low molecular weight heparin (LMWH)
• Direct oral anticoagulants (DOACs)
• Fondaparinux

Correct Answer: Low molecular weight heparin (LMWH)

Q5. Which drug is classically associated with limb defects when taken during early pregnancy?

• Isotretinoin
• Thalidomide
• Warfarin
• ACE inhibitors

Correct Answer: Thalidomide

Q6. Which vitamin supplement is most critical to reduce neural tube defects when given periconceptionally?

• Vitamin B12
• Vitamin C
• Folic acid
• Vitamin D

Correct Answer: Folic acid

Q7. Which class of antihypertensive is contraindicated in pregnancy due to fetal renal dysplasia and oligohydramnios?

• Beta-blockers
• ACE inhibitors
• Calcium channel blockers
• Methyldopa

Correct Answer: ACE inhibitors

Q8. What is the purpose of antenatal corticosteroids (e.g., betamethasone) given between 24–34 weeks?

• Prevent gestational diabetes
• Enhance fetal lung maturation and reduce neonatal RDS
• Treat maternal hypertension
• Prevent oligohydramnios

Correct Answer: Enhance fetal lung maturation and reduce neonatal RDS

Q9. Which antibiotic is contraindicated in pregnancy because it causes permanent tooth discoloration and inhibited bone growth in the fetus?

• Penicillin
• Tetracycline
• Cephalosporin
• Clindamycin

Correct Answer: Tetracycline

Q10. Which drug for seizure control is most strongly associated with an increased risk of neural tube defects and cognitive impairment in exposed fetuses?

• Lamotrigine
• Valproate (valproic acid)
• Levetiracetam
• Carbamazepine

Correct Answer: Valproate (valproic acid)

Q11. Which statement about warfarin use in pregnancy is correct?

• Warfarin is safe in all trimesters
• Warfarin causes fetal hemorrhage and embryopathy, especially in first trimester
• Warfarin does not cross the placenta
• Warfarin is preferred over heparin for pregnant patients

Correct Answer: Warfarin causes fetal hemorrhage and embryopathy, especially in first trimester

Q12. Which analgesic is generally recommended as first-line for pain in pregnancy?

• Ibuprofen throughout pregnancy
• High-dose aspirin
• Acetaminophen (paracetamol)
• Naproxen in third trimester

Correct Answer: Acetaminophen (paracetamol)

Q13. What is the main reason albumin-bound drug fractions change in pregnancy?

• Increased albumin synthesis raising binding
• Decreased plasma albumin leading to higher free drug fraction
• Albumin is replaced by fetal proteins
• Placental destruction of albumin

Correct Answer: Decreased plasma albumin leading to higher free drug fraction

Q14. Which tocolytic is commonly used and acts by blocking L-type calcium channels to relax uterine smooth muscle?

• Indomethacin
• Nifedipine
• Ritodrine
• Oxytocin

Correct Answer: Nifedipine

Q15. Which nonsteroidal anti-inflammatory drug (NSAID) is most concerning in the third trimester due to risk of premature closure of the fetal ductus arteriosus?

• Aspirin low dose
• Ibuprofen
• Acetaminophen
• Topical diclofenac only

Correct Answer: Ibuprofen

Q16. Regarding placental drug transporters, which statement is true?

• P-glycoprotein increases fetal drug exposure by transporting drugs into fetal circulation
• Efflux transporters like P-glycoprotein limit fetal exposure by pumping drugs back to maternal side
• Transporters are absent in first trimester
• All placental transporters favor fetal accumulation

Correct Answer: Efflux transporters like P-glycoprotein limit fetal exposure by pumping drugs back to maternal side

Q17. Which antithyroid drug is preferred in the first trimester to reduce teratogenic risk?

• Methimazole throughout pregnancy
• Propylthiouracil (PTU) in the first trimester
• Radioactive iodine as initial therapy
• No treatment is recommended

Correct Answer: Propylthiouracil (PTU) in the first trimester

Q18. What is the recommended daily dose of folic acid for women planning pregnancy to prevent neural tube defects?

• 0.1 mg daily
• 0.4 mg (400 µg) daily
• 5 mg weekly
• 10 mg daily

Correct Answer: 0.4 mg (400 µg) daily

Q19. Which statement about the Pregnancy and Lactation Labeling Rule (PLLR) is accurate?

• It reintroduced the old FDA letter categories A, B, C, D, X
• It provides narrative risk summaries and clinical information instead of letter categories
• It only applies to over-the-counter drugs
• It mandates use of category X for all teratogens

Correct Answer: It provides narrative risk summaries and clinical information instead of letter categories

Q20. Which drug used for acne must be avoided in pregnancy due to high teratogenic risk and requires strict contraception programs?

• Tretinoin topical
• Isotretinoin oral
• Clindamycin topical
• Azelaic acid

Correct Answer: Isotretinoin oral

Q21. Magnesium sulfate given to women at risk of imminent preterm birth is primarily used for which fetal benefit?

• Improve fetal lung maturity
• Prevent maternal hypertension
• Neuroprotection to reduce cerebral palsy risk
• Prevent fetal arrhythmias

Correct Answer: Neuroprotection to reduce cerebral palsy risk

Q22. Which antibiotic is a preferred choice for treating chlamydial infection in pregnancy?

• Doxycycline
• Azithromycin
• Fluoroquinolone
• Tetracycline

Correct Answer: Azithromycin

Q23. Which medication is commonly used for gestational diabetes when insulin is not feasible and has rising evidence for safety?

• Glyburide (glibenclamide)
• Sitagliptin
• Metformin
• Pioglitazone

Correct Answer: Metformin

Q24. Which statement about insulin use in pregnancy is correct?

• Insulin crosses the placenta and causes fetal hypoglycemia
• Insulin does not cross the placenta and is safe for glycemic control
• Oral insulin is preferred
• Insulin is contraindicated due to teratogenicity

Correct Answer: Insulin does not cross the placenta and is safe for glycemic control

Q25. Which fetal effect is associated with maternal use of ACE inhibitors during the second and third trimesters?

• Neural tube defects
• Fetal renal failure, oligohydramnios, and pulmonary hypoplasia
• Cardiac septal defects only
• Limb reduction defects

Correct Answer: Fetal renal failure, oligohydramnios, and pulmonary hypoplasia

Q26. Which vaccine is recommended during each pregnancy (preferably during third trimester) to protect the newborn from pertussis?

• MMR vaccine
• Live attenuated influenza vaccine
• Tdap (tetanus, diphtheria, acellular pertussis)
• Varicella vaccine

Correct Answer: Tdap (tetanus, diphtheria, acellular pertussis)

Q27. Which antiemetic is commonly used and considered relatively safe in pregnancy for nausea and vomiting?

• Thalidomide
• Ondansetron (with caution)
• Misoprostol
• Isotretinoin

Correct Answer: Ondansetron (with caution)

Q28. What effect does increased maternal cardiac output have on drug pharmacokinetics during pregnancy?

• Decreases hepatic blood flow universally
• May increase hepatic clearance for high-extraction drugs
• Reduces renal clearance
• Causes drug sequestration in placenta only

Correct Answer: May increase hepatic clearance for high-extraction drugs

Q29. Which medication used for bipolar disorder carries a risk of Ebstein anomaly if used in pregnancy?

• Carbamazepine
• Lithium
• Haloperidol
• Lamotrigine

Correct Answer: Lithium

Q30. Which topical medication for skin infections is preferred in pregnancy due to minimal systemic absorption?

• Topical retinoids (oral or topical)
• Topical clindamycin
• Oral tetracyclines
• Topical aminoglycosides

Correct Answer: Topical clindamycin

Q31. Which drug is used to treat preeclampsia severe features to prevent eclamptic seizures?

• Magnesium sulfate
• Low-dose aspirin
• Heparin
• IV furosemide

Correct Answer: Magnesium sulfate

Q32. Which antiretroviral drug is preferred in pregnancy to reduce mother-to-child HIV transmission?

• Stavudine monotherapy
• Combination antiretroviral therapy (cART) with agents known to be safe in pregnancy
• Only zidovudine prophylaxis is effective
• Antiretroviral therapy is contraindicated

Correct Answer: Combination antiretroviral therapy (cART) with agents known to be safe in pregnancy

Q33. Which medication is used antenatally for women with Rhesus-negative mothers to prevent alloimmunization?

• Synthetic anti-Rh peptide
• Rho(D) immune globulin (anti-D Ig)
• High-dose corticosteroids
• IVIG is always required

Correct Answer: Rho(D) immune globulin (anti-D Ig)

Q34. Which of the following drugs is most strongly associated with fetal vitamin K–dependent bleeding if given to the mother near delivery?

• Heparin
• Warfarin
• LMWH
• IV magnesium sulfate

Correct Answer: Warfarin

Q35. Which antifungal is considered relatively safe for topical use in pregnancy but oral azoles like fluconazole carry risk when used in high doses?

• Oral ketoconazole high dose
• Topical clotrimazole
• Intravenous amphotericin B is first-line for mild infection
• Systemic terbinafine is preferred

Correct Answer: Topical clotrimazole

Q36. Which statement best describes cutoffs for organogenesis vulnerability and later functional maturation?

• Organogenesis ends at week 2
• Structural teratogenesis risk is highest during weeks 3–8; functional/ growth effects can occur later
• Teratogenic risk is equal throughout pregnancy
• Functional maturation sensitive period is weeks 1–2

Correct Answer: Structural teratogenesis risk is highest during weeks 3–8; functional/ growth effects can occur later

Q37. Which drug used for medical termination of pregnancy acts as a progesterone receptor antagonist?

• Mifepristone
• Misoprostol
• Oxytocin
• Methergine (methylergometrine)

Correct Answer: Mifepristone

Q38. Which drug is used with mifepristone to induce uterine contractions for medical abortion?

• Oxytocin IV infusion
• Misoprostol (prostaglandin E1 analog)
• Terbutaline
• Magnesium sulfate

Correct Answer: Misoprostol (prostaglandin E1 analog)

Q39. Which antibiotic class should generally be avoided in pregnancy because of potential fetal cartilage toxicity observed in animal studies?

• Beta-lactams
• Fluoroquinolones
• Macrolides
• Glycopeptides

Correct Answer: Fluoroquinolones

Q40. Which maternal change can decrease the plasma concentration of drugs metabolized by CYP3A4 if pregnancy induces this enzyme?

• Decreased hepatic enzyme activity in pregnancy
• Induction of CYP3A4 leading to increased clearance and lower plasma levels
• Complete inhibition of phase II metabolism
• No change in hepatic drug metabolism

Correct Answer: Induction of CYP3A4 leading to increased clearance and lower plasma levels

Q41. Which antimalarial is contraindicated in the first trimester because of teratogenicity concerns and availability of safer alternatives?

• Chloroquine
• Mefloquine (used with caution if indicated)
• Primaquine (avoided in pregnancy)
• Artemisinin derivatives are always contraindicated

Correct Answer: Primaquine (avoided in pregnancy)

Q42. Which calcium supplement habitually recommended in pregnancy helps reduce risk of preeclampsia in populations with low dietary calcium?

• High-dose vitamin D alone
• 1.5–2 g elemental calcium daily in low-calcium-intake populations
• Calcium is contraindicated in pregnancy
• Calcium only after 36 weeks

Correct Answer: 1.5–2 g elemental calcium daily in low-calcium-intake populations

Q43. Which statement about breastfeeding and drug transfer is correct?

• All drugs easily enter breast milk regardless of protein binding
• Lipophilic, low molecular weight, and un-ionized drugs transfer more readily into breast milk
• Large molecules like monoclonal antibodies freely pass into milk and are always absorbed by the infant
• Drug transfer into milk is independent of maternal plasma concentration

Correct Answer: Lipophilic, low molecular weight, and un-ionized drugs transfer more readily into breast milk

Q44. Which drug used for hyperemesis gravidarum has strong evidence for both efficacy and safety and is a combination therapy in some countries?

• Doxylamine-pyridoxine (vitamin B6) combination
• Methotrexate
• Warfarin
• Isotretinoin

Correct Answer: Doxylamine-pyridoxine (vitamin B6) combination

Q45. Which lipid-lowering agent is generally contraindicated in pregnancy due to potential teratogenicity and lack of benefit during pregnancy?

• Bile acid sequestrants
• Statins (HMG-CoA reductase inhibitors)
• Omega-3 fatty acids
• Dietary modification only

Correct Answer: Statins (HMG-CoA reductase inhibitors)

Q46. What is the principal concern with using methotrexate in women of childbearing potential?

• It is ineffective for ectopic pregnancy
• It is a folate antagonist and highly teratogenic, requiring contraception and avoidance during conception
• It enhances fetal growth
• It increases maternal albumin permanently

Correct Answer: It is a folate antagonist and highly teratogenic, requiring contraception and avoidance during conception

Q47. Which agent is preferred for acute severe hypertension in pregnancy requiring rapid control during labor or postpartum?

• Oral ACE inhibitor
• Intravenous labetalol or hydralazine
• Oral nifedipine only
• Warfarin bolus

Correct Answer: Intravenous labetalol or hydralazine

Q48. Which obstetric medication is used prophylactically to reduce postpartum hemorrhage by causing uterine contraction after delivery?

• Magnesium sulfate
• Oxytocin
• Terbutaline
• Indomethacin

Correct Answer: Oxytocin

Q49. Regarding SSRIs in pregnancy, which statement is most accurate?

• All SSRIs are completely safe without any neonatal or fetal risks
• SSRIs may carry small risks such as neonatal adaptation syndrome and possible cardiac defects with certain agents, so benefit–risk must be evaluated
• SSRIs are absolutely contraindicated in breastfeeding
• SSRIs uniformly cause neural tube defects

Correct Answer: SSRIs may carry small risks such as neonatal adaptation syndrome and possible cardiac defects with certain agents, so benefit–risk must be evaluated

Q50. Which counseling point is essential when prescribing any potentially teratogenic drug to a woman of reproductive age?

• Teratogenic risk can be ignored if the drug treats chronic disease
• Always discuss contraception, pregnancy testing, timing of therapy, and documented informed consent about reproductive risks
• No counseling is needed if patient is asymptomatic
• Advise stopping all medications permanently

Correct Answer: Always discuss contraception, pregnancy testing, timing of therapy, and documented informed consent about reproductive risks

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com