Background: Anemia is a clinical sign of the most prevalent nutritional deficiency in pregnant women worldwide. Histopathological study of the placenta provides valuable information on changes due to anemia in pregnancy. Aim: The present study was undertaken to evaluate the significance of macroscopic and histopathological changes in the placenta due to deficiency anemia in pregnancy consequently affecting the delivery outcome. Material and methods: An observational, prospective, cross-sectional study was conducted for one year. All the obstetric patients having hemoglobin (Hb) less than 11gm/dl were included in the study. After applying the exclusion criteria, 57 cases were included in the study. After delivery, the placenta was collected, fixed in formalin, weight measured, dimensions noted and volume was calculated. Gross features were noted and representative tissue was taken for histopathological study. Results: Term pregnancy was found commonly in mild anaemia (17 cases, 30%), preterm delivery in moderate anemia (14 cases, 25%), and Intrauterine fetal death (IUFD) /abortion in severe anemia (2 cases, 3%). The frequency of the presence of increased placental weight, decreased vascularity, increased fibrosis, and endarteritis are obliterans was found significantly higher in higher grades of anemia than in mild anemia. The same gross and histopathological features were significantly associated with poor obstetric outcomes (IUFD/abortion, preterm delivery) than good obstetric outcomes (term pregnancy). Conclusion: Studies of the placenta have a significant role in understanding the pathophysiology of anemia in pregnancy.