Anemia in pregnancy is a major cause of maternal morbidity and mortality and also poses long-term risk to the fetus. As per WHO hemoglobin (Hb) level below 11 g/dL and hematocrit less than 33% in pregnant women is considered as anemia and Hb below 7 g/dL is severe anemia. CDC defines anemia as Hb less than 11 g/dL in first and third trimester and less than 10.5 g/dL in second trimester. WHO estimated prevalence of anemia in pregnant women are 14% in developed and 51% in developing countries and 65–75% in India alone. Prevalence of anemia is highest in South Asia. This chapter covers the etiology of non-nutritional anemia, approach to the patient, clinical examination, and laboratory evaluation of anemia. Advances in management of major hemoglobinopathy with multidisciplinary approach have improved the possibility of successful pregnancy in these patients.