Objective: To investigate the association between anemia and cesarean delivery. Methods:A case-control study was conducted in Saad Abu-Alela Hospital in Khartoum, Sudan from March 1 to November 30, 2107. The cases were women who had cesarean delivery; women who delivered vaginally were the controls. Obstetrics history was gathered using a questionnaire. Results:There was no significant difference in age, parity, residence, job, education, and newborn gender between women who delivered by cesarean (n=130) and women who delivered vaginally (n=260). While mean (SD) of the body mass index (29.3 (5.4) kg/m 2 vs 26.3 (5.6) kg/m 2 , P<0.001) was significantly higher, hemoglobin level (103.0 (8.0) g/L vs 107.0 (8.0) g/L, P=0.001) was significantly lower in women who delivered by cesarean compared with women who delivered vaginally. In logistic regression analyses, age, gravidity, occupation, education, history of miscarriage, and newborn gender were not associated with cesarean delivery; overweight (adjusted odds ratio [AOR] 2.30, 95% confidence interval [CI] 1.24-4.26), obesity (AOR 7.17, 95% CI 3.64-14.13) and anemia (AOR 2.45, 95% CI 1.47-4. 11) were associated with cesarean delivery. Conclusion:The significant association between anemia and cesarean delivery has important implications for the prevention and treatment of anemia among these women. K E Y W O R D S Anemia; Cesarean delivery; Hemoglobin; Maternal outcome; Pregnancy; Sudan 1 | INTRODUCTION Anemia during pregnancy is a public health problem, especially in resource-poor countries, and it is associated with increased risk of adverse effects on both maternal and perinatal outcomes. 1 WHO has defined anemia in pregnancy as a hemoglobin level of less than 110.0 g/L. 2 Global data show that over half (56%) of pregnant women in low-and middle-income countries are anemic. 1 Pregnant women in sub-Saharan Africa (57%) and in South-East Asia have the highest rate of anemia. 2 Anemia during pregnancy can lead to negative maternal and child health effects, such as fetal distress, low birth weight, and preterm delivery, and increase the risk of maternal and perinatal mortality. 3While the effects of anemia on pregnancy outcomes are extensively investigated, 4 the effect of anemia on mode of delivery in not yet fully explored. While some reports showed significant association between anemia and cesarean delivery, 5-9 other reports have shown no association between anemia and cesarean delivery or have shown that anemia reduced the likelihood of cesarean delivery. 5,6 Although the physiological reason for the increased rate of cesarean delivery in women with anemia is not fully understood, some factors such as impair delivery of oxygen and altered feto-placental angiogenesis could explain the association between anemia and cesarean delivery. [10][11][12][13] It is important to investigate the association between anemia and mode of delivery because there has been an increased rate of cesarean deliveries worldwide. The traditional list of indications for cesarean delivery, su...

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