Aim: Assess the predictive value of first-trimester serum PAPP-A and maternal risk factors in the occurrence of small for gestational age (SGA) newborn in our local South Asian population. Materials and methods: Retrospective case series of antenatal women with singleton gestation who underwent the first-trimester combined screening from January 2013 to December 2015 and had regular checkups and delivered with us. The maternal characteristics analyzed include basic demographics, medical history, medication history, obstetric history, and value of PAPP-A MoM. The neonatal outcome analyzed includes gestational age at delivery, and the birth weight of the baby. Women were divided into three groups as low, intermediate, and high risk and outcomes were analyzed. Statistical analysis was done using Fisher's exact test and unpaired t-test. Results: Of the 1,017 antenatal women, 590 met inclusion criteria, of which 40 women delivered SGA, and 550 women delivered non-SGA newborns. Of the 38 antenatal women where PAPP-A MoM ≤ 0.415 MoM, four and 34 delivered SGA, and non-SGA newborns, respectively. Of the 590 women, 507 were low risk, and 77 and six belonged to intermediate and high risk, respectively. 57.14% of the intermediate-risk and 100% in the high-risk group received aspirin. Twelve newborns were SGA in the intermediate-risk and no SGA in the high-risk group. The detection rate for SGA with low PAPP-A in our study was 10%, similar to the study by Nicholaides et al., where the detection rate was 12%. Conclusion: In the absence of past, current risk factors and a PAPP-A >0.415 MoM, the negative predictive value for SGA was 94.47%. Clinical significance: Assessment of risk factors for SGA fetus at booking helps to provide the earliest effective intervention for prevention of SGA.