Objective: To determine the risk of recurrent small for gestational age (SGA) at term and its associated risk factors using a large national database. Design: Retrospective cohort study. Setting: Nationwide (Republic of Korea). Population: Women with two consecutive singleton live births delivered at term (≥37 weeks of gestation) between 2017 and 2021. Methods: This retrospective cohort study used data from the Korea National Health Insurance claims database. Clinical risk factors were compared between women with recurrent SGA birth and non-recurrent SGA birth. Main outcome and measures: Clinical risk factors for recurrent SGA at term. Results: (1) Of a total of 40,317 women, 15.3% had SGA neonates in the first pregnancy, and 22.6% had another SGA in the subsequent pregnancy; (2) women with recurrent SGA had a higher prevalence of underweight (BMI <18.5 kg/m ²), short stature (<160 cm), and anemia (Hb <12 g/dL); (3) logistic regression analysis showed that SGA in the first pregnancy was the strongest predictor of recurrence (adjusted OR [aOR] 1.9, 95% CI 1.7–2.1), followed by pre-pregnancy underweight (aOR 1.5, 95% CI 1.4–1.7), short stature (aOR 1.4, 95% CI 1.3–1.5), and anemia (aOR 1.2, 95% CI 1.0–1.3). Conclusion: SGA often recurs in subsequent pregnancies. Maternal factors such as underweight status, short stature, and anemia, are associated with recurrence at term. This suggests that recurrence at term is often due to constitutional smallness or suboptimal pre-pregnancy nutrition. Since nutrition is modifiable, preconception care plays a critical role in prevention. Key words Anemia, big data, body mass index, fetal growth restriction, preconception, risk factors, short stature, undernutrition.