Objective: To explore the predictive value for fetal growth restriction (FGR) by combining early-pregnancy uterine artery Doppler indices [pulsatility index (PI), resistance index (RI), systolic-to-diastolic velocity ratio (S/D=PSV/EDV), and early diastolic notch] with serum placental growth factor (PLGF) levels. Methods: A retrospective analysis was conducted on the clinical data of pregnant women who received regular prenatal care from July 2024 to October 2025. Based on FGR diagnostic criteria, they were divided into an FGR group (n=39) and a non-FGR group (n=188). First-trimester uterine artery Doppler parameters (PI, RI, S/D), early diastolic notch presence, and serum PLGF levels were compared between the two groups. Independent predictors of FGR were determined through multivariate binary Logistic regression modeling, whereas the predictive accuracy of single and combined parameters was systematically assessed via ROC curve analysis with AUC quantification, enabling stratification of diagnostic performance. Results: Compared with the non-FGR group, pregnant women in the FGR group exhibited higher first-trimester right and left uterine artery PI and S/D values (P<0.001), a higher proportion of early diastolic notches (P=0.003), and lower serum PLGF levels (P=0.011). Although right and left RI values were slightly elevated in the FGR group (P>0.05). Multivariate Logistic regression identified right S/D (OR=1.619), left S/D (OR=1.411), PLGF (OR=0.985), and bilateral early diastolic notches (OR=0.302) as independent predictors of FGR. ROC curve analysis showed AUC values of 0.874, 0.826, 0.629, and 0.643 for right S/D, left S/D, PLGF, and early diastolic notches, respectively, when used individually. The combined model achieved an AUC of 0.918, with a sensitivity of 0.872 and specificity of 0.883, demonstrating superior predictive performance. Conclusion: First-trimester uterine artery Doppler flow spectra and PLGF serve as effective predictors for FGR. Notably, the combined predictive value of bilateral S/D, PLGF levels, and the presence of early diastolic notches is particularly high, with an AUC reaching 0.918.