Previous Pogues albums had focused on an Irish folk/punk rock hybrid. On If I Should Fall from Grace with God, jazz, Spanish folk and Middle Eastern folk were added to the mix. The addition of Spanish and Middle Eastern sounds was a sign of things to come; on 1990's Hell's Ditch these would become more prominent. On this album, however, it was very much Irish folk to the fore, especially on songs such as the title track, "Bottle of Smoke", "Lullaby of London", "Sit Down by the Fire", and the rendition of the traditional jig "The Lark in the Morning" as the coda to "Turkish Song of the Damned". These songs were more typical of earlier Pogues albums, mostly fast and heavily textured. The album was also the first by the band to utilize a complete drum kit.
The album marked the most substantial line-up change to date for The Pogues, as it was the first full-length album on which multi-instrumentalist Terry Woods and bassist Darryl Hunt appear. It also marked the departure of one of the original members, bassist Cait O'Riordan.
The alternative album cover is a collage of faked photos of the group's members, in which their faces have been superimposed onto a shot of Irish author James Joyce. The picture of Joyce appears fourth from the left.
Due to time restriction of a vinyl LP the two tracks "South Australia" and "The Battle March Medley" have been omitted and can be found only on the CD release.
If I Should Fall from Grace with God was well received by critics. Kurt Loder of Rolling Stone stated "obviously the Pogues can do it all. And it sounds as if they've only just begun."Robert Christgau gave the album a B+ and said that "neither pop nor rock nor disco crossover stays these groghounds from the swift accomplishment of their appointed rounds."Allmusic has since awarded the album four and a half out of five stars and its reviewer, Mark Deming, called it "the best album the Pogues would ever make."
In 2006, Q magazine placed the album at #37 in its list of "40 Best Albums of the '80s".