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Background: Herbal and traditional medicines are widely used during pregnancy and breastfeeding, often in the belief that natural products are inherently safe. In India, Ayurvedic preparations are prescribed by practitioners, recommended by family members and bought without prescription. Pregnant and lactating women are, however, among the groups for whom drug safety data are most limited. Objective: To review the classical Ayurvedic guidance on medicines to be avoided in pregnancy, and to summarise current evidence on the safety of herbal medicines, the risk of heavy-metal exposure from herbomineral products, and the status of pharmacovigilance for Ayurvedic medicines in pregnancy and lactation. Methods: Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya and Kashyapa Samhita were reviewed for antenatal prohibitions and harmful factors. PubMed was searched up to October 2026 for studies on herbal medicine use and safety in pregnancy and lactation, heavy metals in Ayurvedic products, and adverse drug reactions to Ayurvedic medicines. Findings were synthesised narratively. Results: The classical texts prohibit sharp, hot and strongly eliminative drugs and therapies during pregnancy and list many factors harmful to the foetus. About one-third of pregnant women worldwide use herbal medicines, and most do not disclose this to their doctors. Pooled observational evidence does not show a general increase in adverse offspring outcomes with herbal use, but signals exist for individual herbs, and data for most Ayurvedic products are absent. Lead, mercury and arsenic have been detected in a substantial proportion of Ayurvedic products, particularly Rasa shastra preparations, and lead poisoning has been documented in pregnant women and children using them. Hospital pharmacovigilance shows adverse reactions to herbal, herbomineral and Panchakarma treatments. Conclusion: Ayurvedic medicines should not be assumed safe in pregnancy or lactation. Prescribing should follow classical prohibitions, avoid unnecessary herbomineral products, use quality-tested medicines and be accompanied by active pharmacovigilance.