Abstract: Objective To analyze the clinical characteristics of twin pregnancies at advanced maternal age and explore perinatal management. Methods A retrospective analysis involved 262 cases of twin pregnancies in our hospital from January 2013 to January 2018 was performed. Sixty-seven cases (≥ 35 years) were included in the advanced age group and 195 cases (＜ 35 years)in the younger age group. The general condition, pregnancy complications and pregnancy outcomes for mother and fetus were compared between the two groups. Results There was no significant difference in body mass index, primipara/multipara, natural pregnancy/ assisted reproductive conception, DCDA/MCDA between two groups (all P＞ 0.05). The incidences of preeclampsia11 cases (16.4%) vs 14 cases (7.2%), gestational diabetes mellitus (GDM) 23 cases (34.3%) vs 31 cases (15.9%), postpartum hemorrhage 38 cases (56.7%) vs 42 cases (21.5%) and premature delivery 47 cases (70.1%) vs 106 cases (54.4%) in the advanced age group were higher than those in the younger age group, and the differences were statistically significant (all P＜ 0.05). While, there was no significant difference in the incidence of neonatal asphyxia, pathological jaundice, infection and NICU conversion between the two groups (all P＞ 0.05). Conclusion In twin pregnancies, pregnant women with advanced maternal age experience significantly higher risk of preeclampsia, GDM, postpartum hemorrhage and premature delivery. While, the risk of neonatal adverse outcomes dose not increased.