<b><i>Background:</i></b> Hypertensive disorders of pregnancy cause fetal growth restriction and increased maternal morbidity and mortality, especially in women of African ancestry. Recently, preeclampsia risk was associated with polymorphisms in the apolipoprotein L1 (<i>APOL1</i>) gene in women of African ancestry. <b><i>Objectives:</i></b> We assessed <i>APOL1</i> genotype effects on pregnancies with and without preeclampsia. <b><i>Method:</i></b> We conducted an unmatched case-control study of 1,358 mother-infant pairs from two independent cohorts of black women. <b><i>Results:</i></b> Term preeclampsia cases with high-risk <i>APOL1</i> genotypes were more likely to be small for gestational age compared to <i>APOL1</i> low-risk term cases (odds ratio [OR] 2.8) and <i>APOL1</i> high-risk controls (OR 5.5). Among preterm pregnancies, fetal <i>APOL1</i> genotype was associated with preeclampsia. <b><i>Conclusions:</i></b> Fetal <i>APOL1</i> genotype was associated with preeclampsia in preterm infants and with altered fetal growth in term infants. This may indicate <i>APOL1</i> genotype impacts a spectrum of pregnancy complications mediated by a common pathophysiological event of placental insufficiency.