Background: Ischemia modified albumin (IMA) rises promptly after an ischemic event and stays elevated for several hours. However, a knowledge gap still exists in terms of the association between intrauterine growth restriction (IUGR) and IMA levels. Objective: The purpose of this study is to ascertain any potential relationships between cord blood IMA levels and IUGR in preterm newborns with or without complex gestations, Methods: A prospective case-control study included 80 mothers of preterm neonates (<37 gestational weeks). Based on antenatal ultrasound findings, eligible women were divided into two groups: case group including the women diagnosed antenatally with IUGR, and control group including women with normal fetal development. The analysis and quantification of the IMA levels was done using a double-antibody sandwich ELISA kit Results: The albumin level was significantly lower in the case group compared to the control group (3.18 ± 0.28 versus 3.88 ± 0.49; p <0.001), while the IMA level was significantly higher in the case group compared to the other group (145 (97.5 - 210) versus 40 (25- 90); p <0.001). At a cut-off point of ≤ 3.4, the albumin had an AUC of 0.993, a sensitivity of 95%, and a specificity of 87.5% for differentiating IUGR. While the cut-off point of IMA of >50 had an AUC of 0.850, a sensitivity of 92.5%, and a specificity of 67.5% for prediction of IUGR. Conclusion: The levels of IMA and albumin in the cord blood have a strong correlation with the IUGR.