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Pregnancy with antenatally unidentified <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> was defined if there was no scan or if the final scan showed estimated fetal weight (<jats:styled-content style=\"fixed-case\">EFW<\/jats:styled-content>) at the 10<jats:sup>th<\/jats:sup> centile or above. Identified <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> was defined if <jats:styled-content style=\"fixed-case\">EFW<\/jats:styled-content> was below the 10<jats:sup>th<\/jats:sup> centile at the last scan. Maternal and fetal sociodemographic and clinical characteristics were studied for associations with unidentified <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> using unadjusted and adjusted logistic regression models. Ultrasound parameters (gestational age at first growth scan, number and frequency of ultrasound scans) were described, stratified by presence of indication for serial ultrasound. Associations of unidentified <jats:styled-content style=\"fixed-case\">SGA<\/jats:styled-content> with absolute centile and percentage weight difference between the last scan and birth were also studied on unadjusted and adjusted logistic regression, according to time between the last scan and birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 15\u2009784 SGA babies included, SGA was not identified antenatally in 78.7% of cases. Of pregnancies with unidentified SGA, 47.1% had no recorded growth scan. Amongst 9410 pregnancies with complete data on key maternal comorbidities and antenatal complications, the risk of unidentified SGA was lower for women with any indication for serial scans (adjusted odds ratio (aOR), 0.56 (95%\u2009CI, 0.49\u20130.64)), for Asian compared with white women (aOR, 0.80 (95%\u2009CI, 0.69\u20130.93)) and for those with non\u2010cephalic presentation at birth (aOR, 0.58 (95%\u2009CI, 0.46\u20130.73)). The risk of unidentified SGA was highest among women with a body mass index (BMI) of 25.0\u201329.9\u2009kg\/m<jats:sup>2<\/jats:sup> (aOR, 1.15 (95%\u2009CI, 1.01\u20131.32)) and lowest in those with underweight BMI (aOR, 0.61 (95%\u2009CI, 0.48\u20130.76)) compared to women with BMI of 18.5\u201324.9\u2009kg\/m<jats:sup>2<\/jats:sup>. Compared to women with identified SGA, those with unidentified SGA had fetuses of higher SGA birth\u2010weight centile (adjusted odds for unidentified SGA increased by 1.21 (95%\u2009CI, 1.18\u20131.23) per one\u2010centile increase between the 0<jats:sup>th<\/jats:sup> and 10<jats:sup>th<\/jats:sup> centiles). Duration between the last scan and birth increased with advancing gestation in pregnancies with unidentified SGA. SGA babies born within a week of the last growth scan had a mean difference between EFW and birth\u2010weight centiles of 19.5 (SD, 13.8) centiles for the unidentified\u2010SGA group and 0.2 (SD, 3.3) centiles for the identified\u2010SGA group (adjusted mean difference between groups, 19.0 (95%\u2009CI, 17.8\u201320.1) centiles).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Unidentified SGA was more common amongst women without an indication for serial ultrasound, and in those with cephalic presentation at birth, BMI of 25.0\u201329.9\u2009kg\/m<jats:sup>2<\/jats:sup> and less severe SGA. Ultrasound EFW was overestimated in women with unidentified SGA. This demonstrates the importance of improving the accuracy of SGA screening strategies in low\u2010risk populations and continuing performance of ultrasound scans for term pregnancies. \u00a9 2022 The Authors. 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