Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our Objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. A study of women older than 45 years at their estimated date of confinement (EDC) was compared with a control group under 36 years at their EDC, matched by parity and plurality. All study patients and controls received uniform obstetric management through a single maternal fetal practice. The primary outcome was gestational age at birth stratified by plurality; secondary outcomes included birth weight, NICU days, composite neonatal morbidity, and a variety of obstetric complications. Wilcoxon signed rank and McNemar’ s tests were used as appropriate; logistic regression was used to calculate odds ratios (ORs) and CIs. Statistical significance was assumed for P <.05. Fifty study and control patients were identified over a 5- year period. Study patients were older than controls, but the difference in “gamete” age was not significant. There was significantly more assisted reproduction (donor egg) and preeclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plurality were not different (86% power to detect 2- week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not different between study patients and controls. When controlled for parity and plurality, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for in the same setting of a high- risk maternal- fetal practice. Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our Objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. A study of women older than 45 years at their estimated date of confinement (EDC) was compared with a control group under 36 years at their EDC, matched by parity and multiple. All study patients and controls received uniform obstetric management through a single maternal fetal practice. The primary outcome was gestational age at birth stratified Wilcoxon signed rank and McNemar’s tests were used as appropriate; logistic regression was used to calculate odds ratios (ORs) and CIs. Statistical significance was assumed for P <.05. Fifty study and control patients were identified over a 5-year period. Study patients was older than controls, but the difference in “gamete ” age was not significant. There was more more assisted reproduction (donor egg) and preeclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plural were not different (86% power to detect 2-week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not different between study patients and controls. When controlled for parity and many, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for the same setting of a high- risk maternal-fetal practice.