Diagnostic X-ray examinations during pregnancy may raise concerns about fetal teratogenicity, and misconceptions can lead to unnecessary anxiety or avoidance of clinically indicated imaging. This study assessed pregnant women’s awareness of the teratogenic effects of X-ray exposure, identified common information sources, and explored associated sociodemographic factors in Makkah, Saudi Arabia. A hospital-based cross-sectional study was conducted over six months at Hera Hospital, enrolling pregnant women aged ≥18 years via convenience sampling. Data were collected anonymously using a structured self-administered questionnaire covering sociodemographic and knowledge/perceptions related to X-ray safety in pregnancy. Awareness was quantified using a 0–10 score derived from five true/false items, information sources, and self-rated knowledge, then categorized as low (<6), moderate (6–8), or high (>8). Descriptive analyses were performed, and chi-square testing assessed associations between awareness level and participant characteristics at p<0.05. The study included 206 pregnant women; most were aged ≥36 years (77.7%), had at least a bachelor’s degree (89.3%), were employed (66.5%), had household income >8000 SAR (74.3%), and were multiparous (73.3%). The mean awareness score was 6.77±1.73 (median 7; IQR 6–8), with 37.4% showing low awareness, 47.6% moderate awareness, and 15.0% high awareness. While many participants correctly rejected the statement that X-rays pose no fetal risk (84.5%) and recognized that high-dose exposure may cause genetic mutations (91.3%), a major gap was observed regarding shielding, as 55.3% believed lead aprons provide complete protection. Healthcare providers were the dominant information source (70.9%), followed by the internet (16.5%), and no significant associations were detected between awareness and age, education, marital status, occupation, income, or parity (all p>0.05). Overall, maternal awareness was generally moderate, but persistent misconceptions especially about radiation protection support the need for targeted, evidence-based antenatal counselling and consistent messaging.