Advanced maternal age (AMA) is linked to several adverse pregnancy outcomes, hence these pregnancies are considered to be "high risk." Risk perception impacts pregnant women’s health care use, health behaviors, and adherence to medical recommendations. Yet, a gap remains in the understanding of perception of pregnancy risk and its contributing factors. This mixed methods research study was developed to address this gap, using a conceptual framework based on a literature review and the Psychometric Model of risk perception. The specific objectives of this study were to compare risk perception in nulliparous women of AMA with younger women, determine the factors influencing perception of pregnancy risk, and gain an understanding of women’s perspectives of risks associated with AMA. Between December 2009 and January 2011, a sample of 159 participants (105 women aged 20-29 years and 54 women aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba. Several questionnaires were completed by participants. Descriptive statistics, chi square, t tests, Pearson's r correlations, and stepwise multivariate linear regressions were used to analyze data. Fifteen women of AMA were chosen purposefully to participate in individual and semi-structured interviews. Interviews were audio-taped and transcribed verbatim, and content analysis was used to identify themes. Results revealed that pregnancy-related anxiety, maternal age, medical risk, perceived control (internal), and gestational age were significant predictors of perception of pregnancy risk accounting for 47-49% of the variance in risk perception. Maternal age interacted in a synergistic manner with pregnancy-related anxiety to increase perception of pregnancy risk levels. In the qualitative component, four main themes emerged from the data: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than younger women. However, they were not a homogenous group in their pregnancy risk appraisal. This study contributed to the field by proposing pregnancy-related anxiety as a pregnancy dread factor in risk perception theories. Risk communication is an important element of developing care plans for women of AMA and should be integrated into prenatal care visits.