Objective: To examine pregnancy outcome among women age 40 years and older. Methods: A retrospective cohort study, including 1404 pregnant women at least 40 years of age and 6978 controls age 20–29 years, was conducted. The two groups were stratified, according to parity, to facilitate separate analysis. Associations between maternal age and pregnancy outcomes were assessed with the contingency x2 or two-tailed Fisher exact test. Multiple logistic regression was used to evaluate these associations and allowed for calculation of adjusted odds ratios (OR). Results: Older gravidas were more likely to develop gestational diabetes (nulliparas: OR 2.7, 95% confidence interval [CI] 1.9–3.7; multiparas: OR 3.8, 95% CI 2.7–5.4), preeclampsia (nulliparas: OR 1.8, 95% CI 1.3–2.6; multiparas: OR 1.9, 95% CI 1.2–2.9), and placenta previa (nulliparas: OR 13.0, 95% CI 4.8–35.0; multiparas: OR 6.4, 95% CI 2.6–15.6). Older women were also at increased risk for cesarean delivery (nulliparas: OR 3.1, 95% CI 2.6–3.7; multiparas: OR 3.3, 95% CI 2.6–4.1), operative vaginal delivery (nulliparas: OR 2.4, 95% CI 1.9–2.9; multiparas: OR 1.5, 95% CI 1.2–1.9), and induction of labor (nulliparas: OR 1.5, 95% CI 1.2–1.8; multiparas: OR 1.4, 95% CI 1.1–1.7). Older nulliparas had an increased incidence of abnormal labor patterns (OR 1.4, 95% CI 1.2–1.7), neonatal intensive care unit admissions (OR 1.6, 95% CI 1.2–2.2), and low 1-minute Apgar scores (OR 2.3, 95% CI 1.1–4.9). Older multiparas were more likely to experience fetal distress (OR 2.0, 95% CI 1.4–2.8), antepartum vaginal bleeding (OR 1.8, 95% CI 1.1–3.1), and preterm premature rupture of membranes (OR 1.7, 95% CI 1.1–2.9). Conclusion: Although maternal morbidity was increased in the older gravidas, the overall neonatal outcome did not appear to be affected.