Objective: The aim of this study is to present pregnancy and perinatal outcomes of twin gestations in older women and compare them with that for younger women. Study design: We conducted a retrospective cohort study of twin pregnancies in our department between 1988 and 2003. The women were classified into two groups by maternal age: women of age 35 years and older (study group) and women less than 35 years (control group). Population characteristics, complications during pregnancy and delivery, and neonatal outcomes were assessed. The Student’s t-test, χ2 test, Fisher exact test, and binary logistic regression analysis were used to examine the relationship between maternal age and the different variables. Results: A total of 238 twin pregnancies were enrolled (study group, 57 women; control group, 181 women). Spontaneous conceptions were significantly higher in the control group (P<0.001), while conceptions after in vitro fertilization (IVF) were significantly higher in study group (P<0.001). Mean figures of gestational age at delivery and birth weight for the older group did not differ significantly from the younger group. Although the antepartum and intrapartum complications were more common in the study group, they were not statistically significant compared to the control group. This was also true for the perinatal outcomes. Only the very low birth weight (VLBW<1,500 g) rate was significantly higher in the study group. The number of perinatal deaths was similar on comparison by maternal age. Conclusions: Based on our study, advanced maternal age at twin gestation does not seem to affect significantly pregnancy complications and perinatal outcomes. VLBW was the only unfavorable perinatal outcome related to advanced maternal age.