Aeroelastic design and fatigue analysis of large utility-scale wind turbine blades have been performed to investigate the applicability of different types of materials in a fatigue environment. The blade designs used in the study are developed according to an iterative numerical design process for realistic wind turbine blades, and the software tool FAST is used for advanced aero-servo-elastic simulations. Elementary beam theory is used to calculate strain time series from these simulations, and the material fatigue is evaluated using established methods. Following wind turbine design standards, the fatigue evaluation is based on a turbulent wind load case. Fatigue damage is estimated based on 100% availability and a site-specific annual wind distribution. Rainflow cycle counting and Miner's sum for cumulative damage prediction is used together with constant life diagrams tailored to actual material S-N data. Material properties are based on 95% survival probability, 95% confidence level, and additional material safety factors to maintain conservative results. Fatigue performance is first evaluated for a baseline blade design of the 10 MW NOWITECH reference wind turbine. Results show that blade damage is dominated by tensile stresses due to poorer tensile fatigue characteristics of the shell glass fiber material. The interaction between turbulent wind and gravitational fluctuations is demonstrated to greatly influence the damage. The need for relevant S-N data to reliably predict fatigue damage accumulation and to avoid nonconservative conclusions is demonstrated. State-of-art wind turbine blade trends are discussed and different design varieties of the baseline blade are analyzed in a parametric study focusing on fatigue performance and material costs. It is observed that higher performance material is more favorable in the spar-cap construction of large blades which are designed for lower wind speeds.