Anemia during pregnancy is the pinnacle of concern for the World Health Organization (WHO) in low- and middle-income countries (LMICs). In these settings, where anemia is often most severe, blood transfusion serves as an important, life-saving intervention for the management of obstetric emergencies and severe cases. Therefore, this emphasizes the need for regular prenatal follow-up and regular screening during pregnancy for early detection and prompt treatment of anemia, thereby preventing progression to critical stages requiring complex interventions. The study objective is to investigate the association of maternal blood traits (ABO and Rh) with anemia and blood transfusion during childbirth. The survey was a retrospective cross-sectional study conducted on 4,919 pregnant women at Al-Wahda Hospital in Derna, Libya, between 2020 and 2023. Venous blood samples were collected for blood type and hemoglobin studies, and the results were statistically analyzed using SPSS for descriptive statistics, chi-square tests, and ANOVA tests. The results of the analysis of 4,919 maternal records revealed a significant association (p = 0.027) between blood characteristics and hemoglobin status, with A-negative characteristics having the highest prevalence of anemia (61.8%). In the group, 527 postpartum women (10.71%) received a total of 1153 blood transfusion units. Mean units transfused increased with the severity of anemia, reaching 3.00 ± 0.816 units for A-positive women with severe anemia. However, inferred statistics using two-way ANOVA showed that neither maternal blood characteristics (P = 0.565), hemoglobin status (P = 0.621), nor their interaction (P = 0.507) had a statistically significant effect on transfusion requirements. The distribution of transfusions is carefully reflected in the cohort, 527 parturient women (10.71%) received a total of 1,153 blood transfusion units. The mean transfusion units increased with anemia severity, peaking at 3.00 ± 0.816 units for severely anaemic A-positive women. However, inferential statistics using two-way ANOVA showed that neither maternal blood trait (P=0.565), haemoglobin status (P=0.621), nor their interaction (P=0.507) had a statistically significant effect on transfusion requirements. The distribution of transfusions closely mirrored the population prevalence of blood traits (O+ 30.17%, A+ 31.67%, B+ 21.25%). Furthermore, the mode of delivery did not significantly influence transfusion rates (P=0.219). The evidence supports implementing universal anaemia screening and management as a priority in prenatal care. Consequently, blood bank inventories require alignment with the population's blood trait distribution (A+ > O+ > B+ > O- > AB+ > A- > B- > AB-). Moreover, clinically, the focus is advised to remain on preventing and managing anaemia and its complications rather than blood traits-based predictions.................. Key words:............... Maternal ABO, Rh, Anaemia, Blood Transfusion.