Objective: Using three-dimensional speckle tracking technology and real-time three-dimensional echocardiography, comparative analysis the change of left ventricular myocardial strain capacity, left ventricular structure and function in different gestational weeks of appropriate age pregnant women and advanced-age women. It is hoped to provide reliable imaging evidence for the early detection of subclinical myocardial injury in advanced maternal age pregnant women. Methods: Select 40 advanced maternal age (pregnancy age ≥ 35 years) singleton pregnant women from February 2020 to March 2021 in our hospital, and match 35 singleton pregnant women of appropriate age (pregnancy age 25-29 years) in the same period. Echocardiographic data were collected during early pregnancy (12 to 14 weeks of gestation), second trimester (24 to 27 weeks of gestation), and third trimester (36 to 39 weeks of gestation), and the two groups of patients were compared with conventional echocardiographic parameters and three-dimensional strain index during different pregnancy periods. Results: In the age-appropriate group, compared with the early and second trimesters, the structural and functional indexes LAD, LVEDV, SV and CO increased during the third trimester (P<0.05); In the advanced maternal age group, compared with the first trimester, the structure and function indexes LAD, LVEDV, SV, CO increased in the second and third trimesters (P<0.05); There was no significant change in LVESV, IVSd, LVPWd, LVEF, at each gestational week of the two groups (P>0.05); comparing the three-dimensional strain parameters between the two groups at the same gestational week, the global longitudinal strain and global circumferential strain of the advanced maternal age group (P<0.05). Conclusion: During pregnancy, the changes in cardiac structure and function of advanced maternal age pregnant women occur earlier than those of appropriate age, and the myocardial strain index can be observed to decrease. The use of three-dimensional speckle tracking technology can detect the myocardial structure and dysfunction of advanced maternal age pregnant women earlier and is a reliable method for advanced maternal age pregnant women to monitor changes in cardiac function.