Pretreatment is widely used in sludge dewatering, however, its potentially impact on the subsequent sludge agricultural applications is often neglected. Here, the potential benefits and risks of the sludge with no pretreatment and with four most commonly used pretreatment methods in sludge agricultural applications were assessed using potted lettuce, an experimental crop. The results show that sewage sludge pretreatment methods can greatly affect its agricultural applications. The application of different pretreatment methods can potentially reduce the harm caused by pathogens. At low dosage (0.2 g kg), different sludge fertilizers promoted an increase in crop yield of 14.6% to 49.1%, and the concentrations of heavy metals in the crop and soil were controlled within safe ranges. At high dosage (8 g kg), crop yield using pretreated sludge (except anaerobic digestion) decreased by between 32.7% and 57.5%, but heavy metal pollution of both crop and soil increased. In terms of promoting crop growth and reducing heavy metal accumulation, untreated sludge was better than pretreated sludges and sludge with physical pretreatments was better than that with chemical pretreatments. Overall, this study clearly shows that the introduction of pretreatment in sludge dewatering can inevitably impact its agricultural land application.