The changing patterns of becoming pregnant at an advanced age have a serious public health impact because of increased risks of adverse outcomes. Thus, the objective of this study was to find the adverse pregnancy outcome of advanced age women delivered at a tertiary hospital in South Africa. This was a retrospective comparative study was conducted targeting the records of pregnant patients who delivered at Dr. George Mukhari Hospital from 1st September to 30th November 2010 where the pregnancy outcomes of females who were more than 34 years old (advanced age women, n=341) were compared with adult women (age between 20 and 34 years, n=1604). Advanced maternal age women had significantly higher rate of preterm delivery (19.2% vs 14.7%), caesarean delivery (38.4% vs 35.3%), breech presentation (7.0% vs 3.9%), and low birth weight rate (27.9% vs 18.8%) compared to adult women (p<0.05). Fresh still birth (FSB) and macerated still birth (MSB) rate was higher (5.6%) among advanced age women compared to adult women (4.8%) but it was not significant (p=0.825). Advanced age women were 1.37 (OR=1.37, p=0.041) times more likely to have preterm delivery, and 1.67 (OR=1.67, p<0.001) times more likely to deliver low birth weight (LBW) babies compared to adult women. The study has shown that advanced age women have higher rates of preterm birth, caesarean delivery, and LBW. Knowledge about the risks associated with advancing age can be helpful for couples in their decisions regarding childbearing.