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To review the literature on the relationship between advanced maternal age and pregnancy outcomes and to discuss social trends in childbearing.Computerized searches on CINAHL, MEDLINE, National Institutes of Health, and published birth statistics. Keywords used in this search were the following: advanced maternal age, pregnancy outcomes for older primiparae and older mothers, and pregnancy risks.Relevant articles published between 1978 and 2001 were reviewed.Data were extracted and organized under the following headings: childbearing trends in developed countries, maternal morbidity for older mothers, preeclampsia, preterm delivery, operative and assisted delivery, and infant mortality and morbidity.The existing literature is concentrated on the medical aspects of the risks associated with childbearing at an advanced maternal age. Few systematic investigations have been undertaken of healthy older mothers, an increasingly common obstetric population.Lifestyle influences, such as weight, general health, and smoking habits in older mothers, have not been addressed. Little is known about the actual risks of pregnancy complications for healthy older mothers. No clear guidelines exist to direct the obstetric and nursing care of the healthy older mother.