Objectives: Small for gestational age (SGA) neonates are at increased risk for perinatal mortality and morbidity; however, the risks can be substantially reduced if the condition is identified prenatally. To investigate the value of combined screening by maternal characteristics and medical history, fetal biometry, and uterine artery pulsatility index values in the prediction of delivery of SGA neonates. Methods: A retrospective cohort study was conducted among patients scanned between 19 and 24 weeks of gestation between January 2010 and June 2018. The main outcome measure was prediction of delivery of preterm and term SGA neonates defined as a birthweight in the lowest centile groups (<10th, <5th and <3rd centiles [INTERGROWTH-21st standard]). Maternal factors included age, parity and medical history. Fetal biometry, birthweight, amniotic fluid index, umbilical artery and uterine artery pulsatility index values were converted into centiles. Multivariable logistic regression analysis was performed and the predictive accuracy was assessed using receiver operating characteristic curve analysis. Results: A total of 6444 singleton pregnancies met all inclusion criteria, including 184 (2.9%), 305 (4.7%), and 670 (10.3%) that delivered SGA neonates with birth weight <5th percentile. The areas under the receiver-operating characteristic (ROC) curves (AUC) and the DRs, at FPRs of 10%, of SGA <3rd, SGA <5th and SGA <10th in screening by a combination of maternal factors, fetal biometry, UtA-PI ranged from 0.62-0.89. Across the continuous scales for these measures, the areas under receiver operating characteristic curves ranged from 0.66-0.88. The screening was more accurate for earlier gestational ages and lower BW centiles. Indeed, in the preterm groups it was possible to predict 66% of preterm (delivered <37 weeks). Conclusions: In this large prospective cohort, second-trimester uterine artery Doppler studies were a clinically useful test for predicting small-for-gestational-age babies. Second-trimester screening can identify the majority of pregnancies at high risk of SGA birth and showed a higher performance for earlier gestational ages at birth and lower birthweight centiles.