Abstract Background Intrauterine growth restriction (IUGR) is one of the causes of perinatal mortality and morbidity. It is the failure of the fetus to achieve intrinsic growth potential. Since IUGR neonates are more likely to suffer complications including perinatal asphyxia, cold stress, hypoglycemia, hypocalcaemia, hyperbilirubinemia, feed intolerance, NEC, sepsis and even mortality. So, it is important that these infants are identified and managed appropriately at birth. Purpose The present study aims to determine the possible association between cord blood ischemia-modified albumin (IMA) levels and intrauterine growth restriction (IUGR) in preterm infants with or without complicated gestations. Patients and Method Eighty mothers and their preterm neonates (<37 weeks’ gestation) identified in 2 groups according to antenatal ultrasound: a group with prospective antenatal diagnosis of IUGR and the other group with normal fetal development, after consideration of inclusion and exclusion criteria. Cord blood Albumin and Ischemia modified albumin were estimated by double-antibody sandwich Enzyme-Linked Immunosorbent Assay (ELISA). Results Cord blood IMA was significantly higher in IUGR group compared to control group. Consequently, albumin level was significantly lower in IUGR group compared to other group. IMA was inversely correlation with Hb level and albumin level was inversely correlated with liver function tests (ALT and AST). Conclusion There is a positive association between IMA level and IUGR. This sent a message that combined antenatal ultrasound and serum IMA is a better predictor of intrauterine growth restriction and subsequent better care of neonates with IUGR.