Fetal growth is the principal issue in antenatal surveillance today. Its urgency is highlighted by audit data showing a powerful association between growth restriction and antepartum stillbirths. Customized growth charts optimize the assessment of fetal growth and birth weight by taking individual physiologic variables into account and by deriving an optimal curve that delineates the potential weight gain in each pregnancy. This results in an increased detection rate of true growth restriction and a reduction in false-positive diagnoses for intrauterine growth restriction. Such advantages have yet to be translated into better screening strategies for early detection of growth restriction.