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Objective: To assess complications of very advanced maternal age (VAMA) pregnancies ≥45 years with and without egg donation (ED). Study design: Obstetric and neonatal complications were studied in 20,659 singleton pregnancies according to three maternal age groups: 20-39, 40-44 [advanced maternal age (AMA)] and ≥45 years (VAMA). Twenty pregnancies within the AMA/LAMA group that were achieved with ED were compared with age-matched controls. Results: AMA mothers were more likely to have higher rates of preterm deliveries (OR 1.25), cesarean sections (OR 1.84) hypertension (OR 1.71) and diabetes (OR 2.45). Their newborns were more frequently small for gestational age (OR 1.30), and were more likely to have high rates of respiratory distress syndrome (OR 1.66), neonatal intensive care admission (OR 1.40) and perinatal/neonatal mortality (OR 1.83). VAMA pregnancies had >50% cesarean section rate and a high rate of diabetes (OR 2.29), hypertension (OR 1.54) and postpartum hemorrhage (OR 5.38). Congenital anomalies were more common among ED pregnancies. Conclusions: The higher rate of pregnancy complications for women ≥40 years is not further increased after 45 years of age. [ABSTRACT FROM AUTHOR]