Objective To explore the relationship between the age at first birth and mild cognitive impairment in the elderly rural women in Guizhou Province, so as to provide scientific basis for improving the current situation of their cognitive function. Methods A total of 1 653 elderly people from 5 townships in 2 counties (districts) of Guizhou Province were selected by multi-stage cluster sampling from July to August, 2019. Among them, 952 rural elderly women were investigated by questionnaire and physical examination, and the cognitive function was tested by Mini-Mental State Examination (MMSE). SPSS 26.0 software was used for univariate χ² or rank sum test, to compare the difference of the cognitive function in old age among rural womon with dfifferent dermgrophic characteristics and ages at first birth, and multivariate Logistic regression was used to analyze the influence of age at first birth on mild cognitive impairment. Results A total of 380 cases of mild cognitive impairment were detected, with a total detection rate of 39.92% (380/952). The results of univariate analysis showed that the differences in the rates of mild cognitive impairment among elderly rural women were statistically significant in terms of the following factors: age groups (χ²=45.074, P<0.001), ethnic groups (χ²=15.979, P<0.001), education level (χ²=10.394, P<0.05), BMI (χ²=18.961, P<0.001), daily exercise time (χ²=9.199, P<0.05), marital status (χ²=13.150, P<0.001), and smoking (χ²=4.318, P<0.05). In the age group of ≥ 70 years old, the detection rate of mild cognitive impairment was higher in those aged above 23 years than those aged ≤ 23 years at first birth, and the total scores of MMSE (Z=-1.961, P<0.05), immediate memory (Z=-2.108, P<0.05), and delayed memory (Z=-3.047, P<0.05) were significantly lower than the latter. The results of multivariate unconditional Logistic regression analysis in the age group ≥ 70 years old showed that the age at first birth > 23 years old (OR=1.537, 95%CI: 1.053-2.244) was a risk factor for mild cognitive impairment. Conclusion The detection rate of mild cognitive impairment is high in rural elderly women in Guizhou Province. The age at first birth may be the etiological clue of mild cognitive impairment in rural women aged 70 and above in Guizhou Province, and its causal relationship needs further study. [ABSTRACT FROM AUTHOR]