The aim of this study was to compare the pregnancy outcome and delivery complications in women 40 years or older (cases) to that of women 20 to 30 years old (controls). Over a 5-year period, 319 cases had a singleton delivery in our institution. These women were compared with 326 controls. Parity was significantly higher in cases compared with controls (3.2 vs. 1.8). Advanced maternal age, compared with younger age, was associated with significantly higher rates of preterm delivery (16.0 vs. 8.0%), cesarean delivery (CS) (31.3 vs. 13.5%), and the occurrence of one or more antepartum complications (29.5 vs. 16.6%). When the two groups were subdivided according to parity, rates of preterm delivery, CS, preeclampsia, gestational diabetes, chronic hypertension, and labor induction were each significantly higher among older multiparas compared with control multiparas. However, only preterm delivery, CS rates, and uterine fibroids were found to be significantly higher in older nulliparous compared with young nulliparous women. We conclude that multiparous women at least 40 years old have a higher antepartum complication rate including intrauterine fetal death compared with younger women.