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Objective  To assess the external validity of all published first‐trimester prediction models based on routinely collected maternal predictors for the risk of small‐ and large‐for‐gestational‐age ( SGA  and  LGA ) infants. Furthermore, the clinical potential of the best‐performing models was evaluated.    Design  Multicentre prospective cohort.    Setting  Thirty‐six midwifery practices and six hospitals (in the Netherlands).    Population  Pregnant women were recruited at <16 weeks of gestation between 1 July 2013 and 31 December 2015.    Methods  Prediction models were systematically selected from the literature. Information on predictors was obtained by a web‐based questionnaire. Birthweight centiles were corrected for gestational age, parity, fetal sex, and ethnicity.    Main outcome measures  Predictive performance was assessed by means of discrimination (C‐statistic) and calibration.    Results  The validation cohort consisted of 2582 pregnant women. The outcomes of  SGA  <10th percentile and  LGA  >90th percentile occurred in 203 and 224 women, respectively. The C‐statistics of the included models ranged from 0.52 to 0.64 for  SGA  ( n  = 6), and from 0.60 to 0.69 for  LGA  ( n  = 6). All models yielded higher C‐statistics for more severe cases of  SGA  (<5th percentile) and  LGA  (>95th percentile). Initial calibration showed poor‐to‐moderate agreement between the predicted probabilities and the observed outcomes, but this improved substantially after recalibration.    Conclusion  The clinical relevance of the models is limited because of their moderate predictive performance, and because the definitions of  SGA  and  LGA  do not exclude constitutionally small or large infants. As most clinically relevant fetal growth deviations are related to ‘vascular’ or ‘metabolic’ factors, models predicting hypertensive disorders and gestational diabetes are likely to be more specific.    Tweetable abstract  The clinical relevance of prediction models for the risk of small‐ and large‐for‐gestational‐age is limited.

bjog: an international journal of obstetrics and gynaecology

External validation and clinical usefulness of first‐trimester prediction models for small‐ and large‐for‐gestational‐age infants: a prospective cohort study