Objective · To explore the risk of adverse pregnancy outcomes in the primiparas and the multiparas with advanced maternal age. Methods · Through a retrospective cohort study, 6 129 elderly women who gave birth to a single child January 2014 to December 2016 in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine were collected to compare the differences in pregnancy outcomes between the primiparas and the multiparas (parity2). Logistic regression analysis was used to evaluate the risk of adverse pregnancy outcomes in the two groups of pregnant women. Results · Compared with the multiparas, the primiparas with advanced maternal age had a higher risk of premature rupture of membranes (adjusted OR1.35, 95% CI 1.18-1.54), preeclampsia/eclampsia (adjusted OR1.99, 95% CI 1.45-2.73), gestational diabetes mellitus (adjusted OR1.32, 95% CI 1.15-1.51), small-for-gestation age (adjusted OR2.49, 95% CI 1.78-3.48), and cesarean section (adjusted OR1.45, 95% CI 1.30-1.62). The birth weight of infants deliveredthe primiparas was slightly lower than that of the multiparas. Conclusion · In the advanced maternal age women, primiparas have a higher risk of adverse perinatal outcomes than multiparas, such as premature rupture of membranes, preeclampsia/eclampsia, gestational diabetes mellitus, small-for-gestation age and cesarean section.