Introduction: Rubella can pose serious risks to pregnant individuals, especially during the first trimester, as maternal infection may lead to congenital rubella syndrome (CRS). Despite ongoing vaccination efforts, cases of rubella infection persist among women of childbearing age. This study aims to assess rubella susceptibility, vaccination coverage, and associated risk factors among pregnant women at Al-Wazarat Healthcare Center in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted over 12 months, enrolling 300 pregnant women aged 18 to 45 years through convenience sampling. Demographic information, obstetric history, rubella vaccination status, prior infection, and laboratory data on rubella-specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were collected from medical records. Results: The mean age of participants was 32.0 years, and 134 (44.7%) had given birth five or more times. Overall, 252 (84%) reported having received a rubella vaccination, although 153 (51%) had unknown vaccination timing. IgM positivity (n=70; 23.3%) indicated recent infection, while 241 (80.3%) tested positive for IgG, suggesting prior exposure or successful immunization. Documented vaccination was significantly associated with lower infection rates (p=0.011), age (p=0.0001), and congenital abnormalities (p=0.004). Conclusion: Although vaccination uptake was high, recent infections and incomplete vaccination records highlight ongoing vulnerabilities to rubella and CRS. Improved immunization tracking, comprehensive antenatal screening, and targeted education for both patients and healthcare providers may reduce rubella susceptibility and safeguard maternal and child health.