Background: In Arab countries, many women continue to get pregnant until very advanced age. Many studies have investigated the outcomes of pregnancies in women above the age of 35. However, as it is such a controversial topic, there is no certain answer as to whether or not advanced maternal pregnancies affect the mother and baby’s health. This study aims to describe the maternal and neonatal outcomes of pregnancy at 45 years and beyond. Results: A retrospective review of three hospitals records from Riyadh encompassing 15,415 deliveries was carried out. Out of them, 84 women (6 per 1000) aged 45 or more delivered. About 11% of deliveries were preterm and 38% were by Cesarean Section. Low birth weight was reported in 10% of cases and no stillbirth occurred among the studied sample. Conclusion: Overall, the maternal and neonatal outcomes in this studied sample did not show grave consequences of conceiving at very advanced maternal age. The Saudi mothers suffered from co morbidities such as diabetes and hypertension, which are expected to be common among non-pregnant women of the same age. The preterm labor and low birth weight were lower than those reported globally and comparable to those reported in Saudi Arabia.