Objective: The aim of our study is to assess the prevalence of anemia in pregnant women, and to evaluate the effect of severity of anemia on maternal and perinatal outcome. Methods: This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology from hospital records. Study population of all pregnant women who had delivered in our hospital after twenty weeks gestation between July 2014 and December 2016. Results: A total of 2654 pregnant women fulfilled the inclusion criteria, 42% were anemic, 83.3% mild anemia group (I) which represents the majority of patients and 16.7% moderate to severe anemia group (II). The majority of cases were due to iron deficiency anemia 92.8%, while 7.2% were due to sickle cell trait, B-thalassemia intermedia, and other causes. The incidence of postpartum hemorrhage, cesarean delivery, and infections was significantly higher in group II compared to group I (5.4%, 40.3%, 3.8% Vs, 2.9%, 31.0%, 2.0%; p = 0.007, 0.041, 0.043 respectively). Low Apgar score, preterm labor, and low birth weight babies were significantly higher in group II compared to group I (11.8%, 12.9%, 11.3% Vs 8.7%, 9.0%, 7.4%; p = 0.034, 0.046, 0.032). Conclusions: This study clarified that anemia is prevalent among pregnant women particularly mild anemia. Early diagnosis and treatment from first trimester has an essential role in managing maternal anemia and it reflects directly on the perinatal outcome. Prematurity, low birth weight infants, and postpartum hemorrhage are the commonest maternal and neonatal complications.