Introduction:  Growth‐restricted fetuses are at increased risk of adverse perinatal outcome when compared to their normally grown counterparts. The additional risks associated with growth restriction in preterm fetuses are not well quantified, and this meta‐analysis serves to address this uncertainty. Materials and Methods:  This is a meta‐analysis and meta‐regression of all relevant studies published since 1997 investigating perinatal outcome in preterm growth‐restricted fetuses. Results:  Growth‐restricted fetuses across all gestational ages were found to be at significant risk of having low Apgar scores at 5 min, sepsis, intracranial haemorrhage, intrauterine and neonatal death, necrotising enterocolitis and respiratory complications. Although this risk reduced as gestation increased, it remained amplified in growth‐restricted fetuses when compared to normally grown fetuses. Conclusion:  This large meta‐analysis for the first time quantifies the additional perinatal risks associated with preterm fetal growth restriction and may help counsel parents about the complications these fetuses face following birth.