Background: Increasing maternal age is independently associated with specific adverse pregnancy outcome. But, it was noted when patients of advanced maternal age were followed and delivered their infants in modern tertiary care center, no increase in adverse outcome was noted. Objectives: This prospective study in which maternal and perinatal outcome in pregnant women aged 40 years and above compared with those of young women aged 25-35 who delivered in El-Eman General Hospital. Patients and methods: 422 women were divided into 2 groups. The first group contain 211 women whose age ranges from 25-35 years, the second group contain 211 women whose age 40 years and above. Results: There were significant increases in rates of Pregnancy Induced Hypertension among pregnant women aged over 40 years (12.3%) compared to older primigravida aged over 40 years. There was significant increase in the rate of preeclampsia among women aged over 40 years (18.5%). Incidence of preeclampsia increase in grand muliparus women aged ≥ 40 years (18.5%) and among women aged 25-23 years (7.6%). Risk of bad perinatal outcomes increases in relation to medical diseases with pregnancy. Conclusion: Women aged ≥ 40 years have higher risk of Cesarean section than young women. There were statistically significant increases in the rate of NICU referral due to perinatal problems among women with advanced age. The mother's high age can be an independent factor for adverse pregnancy outcomes, complete awareness of pregnancy outcomes in these age groups for midwives and gynecologist is needed to protect health of mothers.