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Medication compliance is crucial to patient care and clinical objectives. One of the healthcare system's primary challenges is patient non-adherence to medications. This study aims to evaluate medication adherence for diabetes mellitus during pregnancy. In this cross-sectional study, Saudi pregnant women either with diabetes or gestational diabetes mellitus (GDM) participated in self-reported antidiabetic medication adherence using the Moriskey adherence scale, MMAS-4, while attending their antenatal follow-up visits at a large tertiary hospital in Riyadh, Saudi Arabia. We collected data from 180 participants, 107 (59.4%) of them were in their 3rd decade of age (31-40). GDM constituted 46.1% of pregnant women, of whom 55.6% received insulin and 43.9% without comorbidities. The chi-squared test and two-way cross-tabulation showed that the type of diabetic medicine had a statistically significant effect (P = .04). Adherence to diabetes medication was also linked to A1C levels (P = .04). According to MMAS-4, 76 respondents (42.2%) had intermediate diabetes treatment adherence, 40% (n = 72) had high adherence, and 17.8% (n = 32) had low adherence. Saudi pregnant women exhibited inadequate medication adherence levels despite the provision of complimentary medications and extensive healthcare access at the health care facility. In order to identify patients who are not adhering to their drug regimens, antenatal clinics should include a validated medication adherence measure in all patient care plans.