Anemia in pregnancy is a major health problem in developing countries. The erythropoiesis is accelerated during pregnancy resulting in increased number of circulating RBCs. Iron is an essential constituent of the body, being necessary for formation of hemoglobin and for oxidative processes of living tissues. Iron is absorbed mainly in the duodenum and jejunum. The absorption is aided by the acid secretion of the stomach and is more readily affected when the iron is in ferrous state or it is a part of heme complex. The fetus derives its iron from the maternal serum by active transport across the placenta predominantly in the later half of gestation. There is varying degree of pallor of skin and mucous membranes, tachycardia and swelling of legs, glossitis and stomatitis. In chronic cases, koilonychia may be present. A soft systolic murmur in mitral area and crepitations at the base of the lungs may be present. Stool examination should be carried out to detect worm infestation and to rule out occult blood loss. Routine examination of urine is essential and culture and sensitivity should be obtained in cases of suspected urinary tract infection. Parenteral iron therapy should be considered in those cases who cannot tolerate oral iron therapy or when the compliance is not good. The reticuloendothelial cells gradually separate iron from iron dextran complex. The main advantage of intravenous therapy is the certainty of its administration to correct the hemoglobin deficit and to fix up the store iron. Patient should be closely observed for development of infection, congestive cardiac failure and puerperal venous thrombosis. Blood transfusion in puerperium is considered only if there is severe anemia. Bone marrow is predominantly macrocytic. The treatment consists of supplementation of all precursors.